https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Köln Herzzentrum - Kardiologie Köln, Deutschland; 2Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 4Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland
Background: Transcatheter tricuspid valve repair (TTVr) has emerged as a treatment option for tricuspid regurgitation (TR) in patients with high surgical risk. Given the heterogeneity in clinical benefit, there is a need for markers to predict which patients benefit from TTVr. The C-reactive protein (CRP)/albumin ratio (CAR) is a marker of systemic inflammation and reduced nutritional status, which both can occur in TR with progressive right-heart failure. CAR is associated with mortality in other valvular diseases like aortic stenosis. Data about CAR in the setting of TTVr are lacking.
Aim: To evaluate CAR as a marker for mortality after TTVr.
Methods: We retrospectively analyzed 215 consecutive patients who underwent TTVr at a tertiary care center. Serum CRP and albumin were collected at baseline accompanied by clinical, echocardiographic, invasive hemodynamic and procedural parameters. Intraprocedural success was defined as a TR reduction of ≥ 2. Mortality was assessed up to 2 years after procedure.
Results: The study population was mostly female (69.3 %) with a median age of 80 years. Intraprocedural success was achieved in 65.1 % of patients. Area under the curve (AUC) of CAR for 2-year mortality was 0.695, with an optimal threshold of 1.2945 dividing patients in high and low CAR groups. Patients with high CAR had decreased survival (Mortality 40.9 % vs 14 %, p < 0.001, Figure 1) and significantly higher invasively measured mean right atrial pressure, worse renal function, and less successful TTVr. High CAR was independently associated with an increased risk of death even when adjusted for NYHA functional class, estimated glomerular filtration rate, bilirubin, fractional area change and unsuccessful intervention (HR 2.264; 95% CI 1.231 – 4.163; p = 0.009). CAR had a better AUC than EuroSCORE II (AUC 0.695 vs 0.654), but a lower AUC than the multiparametric TRI-SCORE (AUC 0.750 vs 0.695). However, adding CAR to TRI-SCORE improved its predictive value (AUC 0.765 vs 0.750).
Conclusion: CAR is associated with higher mortality after TTVr and might represent patients with end-stage right heart failure, systemic inflammation, and malnutrition. CAR is calculated easily from everyday practice parameters and might be used in adjunction to established risk scores, but further investigations are warranted to explore its full value.
Figure 1: Kaplan-Meier curve of estimated survival comparing high and low CAR groups (Cut-off CAR 1.2945). Significantly higher mortality in the high CAR group (p < 0.001, log rank test). CAR = CRP/Albumin ratio.