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Transcatheter Tricuspid Valve Intervention Risk Scores: Assessment in an International Multicenter Cohort
Max Potratz1, Akhil Narang2, Muhammed Gerçek1
1Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany; Herz- und Diabeteszentrum NRW, Medizinische Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, Germany; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Current risk scores for transcatheter tricuspid valve intervention (TTVI) show limitations. New models are needed for accurate risk stratification in TTVI patients, as existing surgical and early TTVI scores are miscalibrated or lack discrimination.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Accurate risk stratification is essential for patients undergoing transcatheter tricuspid valve intervention (TTVI).
- Existing surgical and TTVI risk scores (TRI-SCORE, STS-TR, TRIVALVE) require comprehensive evaluation in contemporary, real-world TTVI populations.
Purpose of the Study:
- To assess the discrimination and calibration of established risk scores in a large international multicenter cohort of patients undergoing TTVI.
- To compare the performance of TRI-SCORE, STS-TR, and TRIVALVE scores for predicting outcomes in TTVI patients.
Main Methods:
- Analysis of 457 patients undergoing TTVI (edge-to-edge repair, replacement, annuloplasty) across 6 international centers (2019-2024).
- Evaluation of TRIVALVE score for 1-year death/rehospitalization; TRI-SCORE for in-hospital mortality; STS-TR for 30-day mortality.
- Performance assessment using C statistics (discrimination) and smoothed calibration plots (calibration).
Main Results:
- All evaluated scores demonstrated limitations in predicting TTVI outcomes.
- TRIVALVE score exhibited low discrimination (AUC: 0.609) but showed good calibration after endpoint refinement.
- Surgically derived TRI-SCORE and STS-TR scores were miscalibrated, significantly overestimating mortality (Observed-to-Expected ratios: 0.13 and 0.35, respectively).
Conclusions:
- Current risk scores derived from surgical or early TTVI cohorts are not well-suited for contemporary TTVI patient risk assessment.
- Surgical scores miscalibrate when applied to TTVI, and the TRIVALVE score lacks sufficient discrimination.
- There is a critical need for developing and validating a new, dedicated risk model specifically for contemporary TTVI populations.
