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. 2025 Jul;114(7):892-903.
doi: 10.1007/s00392-025-02641-4. Epub 2025 Apr 10.

C-reactive protein-to-albumin ratio is associated with mortality after transcatheter tricuspid valve repair

Karl Finke  1 , Laura Marx  2 , Jan Althoff  2 , Thorsten Gietzen  2 , Matthieu Schäfer  2 , Jan Wrobel  2 , Philipp von Stein  2   3 , Jennifer von Stein  2   3 , Maria Isabel Körber  2 , Stephan Baldus  2 , Roman Pfister  2 , Christos Iliadis  2
Affiliations

C-reactive protein-to-albumin ratio is associated with mortality after transcatheter tricuspid valve repair

Karl Finke et al. Clin Res Cardiol. 2025 Jul.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Biomarker; Inflammation; Malnutrition; Right heart failure; Transcatheter tricuspid valve repair; Tricuspid regurgitation.

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Conflict of interest statement

Declarations. Conflict of interest: KF, LM, TG, JA, MS, PvS, and JvS report no relevant disclosures. CI and MIK have received travel support by Abbott and Edwards Lifesciences and consultant honoraria by Abbott Vascular and Edwards Lifesciences. SB has received an unrestricted research grant for the MATTERHORN trial—Abbott Vascular and consultant honoraria from Edwards Lifesciences. RP has a speaker engagement with Abbott Vascular and consultant for Edwards Lifesciences.

Figures

Fig. 1
Fig. 1
Percentages of tricuspid regurgitation (TR) grades before and after transcatheter tricuspid valve repair (TTVr) in the overall study population
Fig. 2
Fig. 2
Receiver-operating characteristics curve for the CRP/albumin ratio predicting death after interventional tricuspid valve repair. Area under the curve was 0.695
Fig. 3
Fig. 3
Kaplan–Meier curve of estimated survival comparing high and low CAR groups. Optimal Cut-off for CAR was 1.2945 (Youden-Index). Significantly higher mortality in the high CAR group (p < 0.001, log rank test). CAR CRP/Albumin ratio
Fig. 4
Fig. 4
Kaplan–Meier curve of estimated survival comparing high and low CAR groups with and without intraprocedural success according to TVARC. Optimal cut-off for CAR was 1.2945 (Youden Index). Significantly higher mortality in the high CAR group with procedural failure (p < 0.001, log-rank test). CAR CRP/Albumin ratio, TVARC Tricuspid Valve Academic Research Consortium
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