Prognostic Performance of a Modified TRI-SCORE Incorporating RV-PA Uncoupling After Transcatheter Tricuspid Valve...

The TRI-SCORE was developed to predict mortality after tricuspid valve surgery and has demonstrated prognostic value in patients undergoing transcatheter tricuspid valve interventions (TTVI). Right ventricular-pulmonary arterial (RV-PA) uncoupling assessed by the TAPSE/sPAP ratio has emerged as a prognostic marker in selected populations; however, its incremental value within established risk scores remains unclear.

In this prospective single-centre cohort, 109 patients undergoing TTVI were included. The original TRI-SCORE was calculated for all patients. A modified TRI-SCORE was proposed by substituting the definition of right ventricular dysfunction based on TAPSE with RV-PA uncoupling, defined as TAPSE/sPAP <0.406 using invasively measured systolic pulmonary artery pressure. The endpoints were 12-month all-cause mortality and a combined endpoint of death or cardiovascular rehospitalization.

At 12 months, all-cause mortality occurred in 19.3% of patients, and the combined endpoint in 40.4%. Both original and modified TRI-SCOREs were significantly associated with 12-month mortality (OR 1.80 per point increase, 95% CI 1.30-2.48; p < 0.001 and OR 1.81 per point increase, 95% CI 1.31-2.49; p < 0.001, respectively) and demonstrated comparable discrimination (AUC 0.78 for both; DeLong p = 0.90). Furthermore, both scores were significantly associated with the combined endpoint (TRI-SCORE: OR 1.36 per point increase, 95% CI 1.08-1.71; p = 0.008; modified TRI-SCORE; OR of 1.33 per one-point increase, 95% CI 1.07-1.66; p = 0.009) with modest and comparable AUCs (~0.65).

In patients undergoing TTVI, replacing TAPSE with RV-PA uncoupling did not improve the prognostic performance of the TRI-SCORE for mortality or combined clinical outcomes.