The value of Troponin T to predict outcome in severe tricuspid regurgitation with and without edge to edge repair

Ruben Gößmann (Heidelberg)1, M. Kraus (Heidelberg)1, I. Hörbrand (Heidelberg)1, H. Hund (Heidelberg)1, S. Hamed (Heidelberg)2, N. A. Geis (Heidelberg)1, M. Gruber (Heidelberg)1, P. Schlegel (Heidelberg)1, N. Frey (Heidelberg)1, M. Konstandin (Heidelberg)1

1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Universitätsklinikum Heidelberg Innere Medizin III, Inst. für Molekulare und Translationale Kardiologie Heidelberg, Deutschland


Recently, improvement in quality of life could be shown for patients with severe tricuspid regurgitation (TR) treated with tricuspid transcatheter-edge-to-edge repair (t-TEER). However, data to also prove gain in survival and prevention of hospitalization by t-TEER are still missing. Therefore, the identification of the right cohort to benefit from interventions with t-TEER is of crucial interest. This study investigates high sensitivity Troponin T (hsTnT) as a possible predictor of outcome.
A prospective interventional cohort of 67 patients undergoing t-TEER as well as a retrospective cohort of 682 patients with at least moderate-severe tricuspid regurgitation (TR) were included in this analysis. Primary endpoint was all cause mortality, secondary endpoint was re-hospitalization due to cardiac decompensation. HsTnT along with Triscore , and clinical and laboratory parameters were entered in a univariate and then multiple Cox’ proportional hazards model. A matched sample from the retrospective cohort based on the results of the multiple model was compared to the interventional group. A cut-off for hsTnT of 53pg/mL was calculated using maximum of the sum of sensitivity and specificity and patients were divided in “high risk” and “low risk” accordingly. 
HsTnT and Triscore as well as NYHA functional class were significant predictors of the primary and secondary outcome in both cohorts. HsTnT remained a significant predictor of both endpoints in both cohorts independent from Triscore value (hazard ratio for survival 1.004 and 1.013, p<0.001 and p=0.02, hazard ratio for combined endpoint 1.0002 and 1.007, p=0.004 and p=0.021 respectively) . In the matched cohort analysis high risk patients did not show a benefit by t-TEER treatment, while low risk patients showed significant improvement of survival and hospitalization by t-TEER intervention. 
HsTnT is a good predictor for death and hospitalization in patients with TR with or without t-TEER. Interestingly, in the matched cohort analysis only patients with hsTnT below 53 pg/ml show favorable outcome regarding survival when treated with t-TEER (log rank test p=0.006). Therefore, hsTnT might be helpful in the workup to identify patients with maximal benefit from t-TEER intervention.
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