Fibrosis-4 Index for Liver Fibrosis (FIB-4) predicts outcome after transcatheter tricuspid valve repair

M. Winkler (Homburg/Saar)¹, M. Altay (Homburg/Saar)², F. S. Küting (Homburg/Saar)², L. Kremb (Homburg/Saar)¹, C. Gräßer (München)³, M. Tokcan (Homburg/Saar)², J. Hövelmann (Homburg/Saar)², T. Lagendijk (Homburg/Saar)², M. Böhm (Homburg/Saar)², B. Scheller (Homburg/Saar)², S. Kulenthiran (Homburg/Saar)², T. Keßler (Homburg/Saar)^2
1Universitätsklinikum des Saarlandes Klinik für Innere Medizin III Homburg/Saar, Deutschland; ²Universitätsklinikum des Saarlandes Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar, Deutschland; ³Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland

Background:
Tricuspid regurgitation is a cardiac disease that leads to multi-organ involvement in advanced stages. This includes impairment of liver veins hemodynamics, eventually leading to liver fibrosis and cirrhosis with detrimental effects on hepatic function. The Fibrosis-4 Index (FIB-4) is a surrogate marker for liver fibrosis and consists of age, aminotransferases and whole-blood platelet counts. FIB-4 has been identified as a prognostic marker in patients with atrial fibrillation and was positively associated with the severity of tricuspid regurgitation. However, the association of FIB-4 with outcomes after tricuspid valve edge-to-edge repair (T-TEER) has not been studied yet. 

Methods and Results:
We retrospectively screened patients undergoing T-TEER between 04/2022 and 05/2026 in a tertiary care center in Homburg/Saar, Germany. After excluding 2 patients due to cardiogenic shock, we analyzed 57 patients, with the high FIB-4 group (>2.67) consisting of 37 patients. Both groups showed similar baseline characteristics with no clinically meaningful differences regarding NYHA class, right ventricular function, systolic pulmonary pressure, heart failure type and concomitant mitral valve disease. After a follow-up of 1 year, high FIB-4 was significantly associated with an increased risk of hospitalization for heart failure (42 vs. 35 %; HR 1.21 95 % CI 1.13 - 1.40; p<0.01) as well as more pronounced (> grade 2) residual tricuspid regurgitation (51 vs. 39 %; p<0.05). 

Conclusions:
In patients undergoing transcatheter tricuspid valve repair, the Fibrosis-4 Index for Liver Fibrosis (FIB-4) was positively associated with residual tricuspid regurgitation and hospitalization for heart failure and might be established as a marker for timing an intervention to modify the trajectory of tricuspid valve disease.