Finke Karl, Marx Laura, Althoff Jan, Gietzen Thorsten, Schäfer Matthieu, Wrobel Jan, von Stein Philipp, von Stein Jennifer, Körber Maria Isabel, Baldus Stephan, Pfister Roman, Iliadis Christos
Faculty of Medicine, Department III of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
Cardiovascular Research Foundation, New York, United States.
Clin Res Cardiol. 2025 Apr 10. doi: 10.1007/s00392-025-02641-4.
Transcatheter tricuspid valve repair (TTVr) is 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 assess mortality risk in patients undergoing TTVr. The C-reactive protein (CRP)/albumin ratio (CAR) is a marker of systemic inflammation and reduced nutritional status, which can both occur in TR.
Consecutive patients undergoing TTVr at a tertiary care center were retrospectively analyzed. Serum CRP and albumin were collected at baseline. Intraprocedural success (IS) was defined according to TVARC criteria. The primary outcome of all-cause mortality was assessed up to 2 years after TTVr.
A total of 215 patients (69% females, median age 80 years) were identified. IS was achieved in 61% of patients. AUC of CAR for 2-year mortality was 0.695, with an optimal threshold of 1.2945 (Youden index) dividing patients in high CAR (n = 93) and low CAR (n = 122) groups. In the high CAR group, the primary endpoint occurred more frequently (43% vs 15%, p < 0.001) and significantly higher right atrial pressure, worse renal function, and less IS during TTVr were observed. High CAR was independently associated with an increased mortality risk even when adjusted for renal and liver function, right-ventricular function, and procedural failure (HR 2.188; 95%CI 1.2-3.9; p = 0.011).
Higher CAR reflects patients with advanced right-heart failure and extracardiac organ damage and is associated with mortality after TTVr. CAR is derived from readily available parameters and may be useful additive to established risk scores.
经导管三尖瓣修复术（TTVr）是手术风险高的三尖瓣反流（TR）患者的一种治疗选择。鉴于临床获益存在异质性，需要有标志物来评估接受TTVr治疗患者的死亡风险。C反应蛋白（CRP）/白蛋白比值（CAR）是全身炎症和营养状况降低的标志物，这两种情况在TR中均可能出现。
对一家三级医疗中心连续接受TTVr治疗的患者进行回顾性分析。在基线时收集血清CRP和白蛋白。术中成功（IS）根据TVARC标准定义。评估TTVr术后2年全因死亡率的主要结局。
共确定215例患者（69%为女性，中位年龄80岁）。61%的患者实现了术中成功。CAR预测2年死亡率的曲线下面积（AUC）为0.695，最佳阈值为1.2945（约登指数），将患者分为高CAR组（n = 93）和低CAR组（n = 122）。在高CAR组中，主要终点更频繁出现（43%对15%，p < 0.001），并且观察到右心房压力显著更高、肾功能更差以及TTVr期间术中成功率更低。即使在调整肾功能、肝功能、右心室功能和手术失败因素后，高CAR仍与死亡风险增加独立相关（风险比2.188；95%置信区间1.2 - 3.9；p = 0.011）。
较高的CAR反映右心衰竭晚期和心外器官损伤的患者，并与TTVr术后死亡率相关。CAR由易于获得的参数得出，可能是对既定风险评分有用的补充指标。
