Association of pre- and postprocedural troponin dynamics and clinical outcome following direct annuloplasty for secondary tricuspid regurgitation

Jan Leonhard Althoff (Köln)1, C. Hasse (Köln)2, T. Gietzen (Köln)2, J. von Stein (Köln)3, J. Wrobel (Köln)2, C. Iliadis (Köln)2, V. Rudolph (Bad Oeynhausen)4, M. Gercek (Bad Oeynhausen)4, K. Friedrichs (Bad Oeynhausen)5, D. Kalbacher (Hamburg)6, B. Köll (Hamburg)7, S. Baldus (Köln)3, R. Pfister (Köln)2, M. I. Körber (Köln)2

1Universitätsklinikum Köln Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 3Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 4Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 5Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland; 6Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 7Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland



Cardiac troponin is known to be a strong prognostic biomarker following valvular interventions. Nonetheless, there is limited evidence regarding its predictive significance in individuals undergoing transcatheter tricuspid valve direct annuloplasty for secondary tricuspid regurgitation (TTVA).


Methods and Results:

In this retrospectively analysis, 165 patients who underwent TTVA at three German centers (Heart Centers Cologne, Hamburg, and Bad Oeynhausen) from 2017 to 2022 were included. 

Patients exhibited at least severe (grade III) tricuspid regurgitation (TR) and were highly symptomatic (90.3% in NYHA class III or IV).

The primary endpoint was all-cause mortality within a median follow up-period of 498 days (264 – 819).

Among the 165 patients, baseline troponin values were available for 107 patients. Patients were categorized into “very low troponin” and “high troponin” groups, accounting for variations in troponin assays across centers and collectively analyzed (Very low troponin: 1st quartile; High troponin: 2nd-4th quartile). At baseline, the high troponin group exhibited significantly more men (P=0.032), a higher EuroScore II (P=0.039), higher serum creatinine levels, and a lower glomerular filtration rate (GFR) (P<0.001). Kaplan-Meier analysis showed significantly worse survival for patients in the high baseline troponin group (log-rank test: P=0.037; Fig. 1).


Subsequent analysis of postprocedural troponin levels and periprocedural dynamics revealed no significant differences in survival rates based on troponin levels 24 hours after the procedure (Very low troponin: 1st quartile; High troponin: 2nd-4th quartile; Log rank test: P=0.33).

Grouping patients by median troponin dynamics within each comparison group (Low Troponin: below the median; High Troponin: above the median) revealed no differences in survival over the follow-up period (log-rank test: P=0.70). 

Additionally, subdividing the cohort into four groups based on a combination of pre- and postprocedural median troponin values (Low/Low; High/Low; Low/High; High/High) revealed no significant survival benefit among these groups (log-rank test: P=0.19). Multivariate Cox regression analysis did not show a significant association of postprocedural troponin increase on survival, whereas factors such as sex, EuroScore II, or baseline TR demonstrated a significant impact (Troponin group: P=0.62; Sex: P=0.010; EuroScore II: P=0.029; TR: P=0.036). 



Baseline troponin levels predicted long-term survival in this real-word collective of patients undergoing TTVA, highlighting a high-risk patient subgroup. Despite an expected increase in troponin levels shortly after the procedure due to anchor penetration of the myocardium, the findings of this study indicate that this postprocedural myocardial injury does not negatively impact patient survival, supporting the technical safety of the procedure.

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