Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Tricuspid regurgitation (TR) is a progressive condition with a poor prognosis, often underdiagnosed.
• Current risk models like the TRI-SCORE lack crucial echocardiographic data on right ventricular (RV) function and RV-pulmonary artery coupling.

Purpose of the Study:

• To determine if integrating simple echocardiographic indices (TAPSE/PASP, TAPSE/RVAD, TAPSE/RVAS) improves the prognostic accuracy of the TRI-SCORE in moderate-to-severe TR patients.
• To assess the incremental predictive value of these echocardiographic ratios beyond the existing TRI-SCORE.

Main Methods:

• Retrospective analysis of 93 patients with severe TR (various etiologies) treated medically or interventionally.
• Primary endpoint: all-cause mortality. Secondary endpoint: mortality or heart failure hospitalization.
• Multivariable Cox regression and spline regression were used to evaluate prognostic performance and identify optimal thresholds.

Main Results:

• Lower values of TAPSE/PASP, TAPSE/RVAD, and TAPSE/RVAS were independently associated with adverse outcomes.
• Each echocardiographic index significantly improved the TRI-SCORE's risk discrimination (C-index increased from 0.614 to 0.710 for TAPSE/PASP).
• Prognostically relevant cut-offs were identified for each ratio.

Conclusions:

• Simple echocardiographic indices of RV function offer significant incremental prognostic value when combined with the TRI-SCORE.
• This integration can enhance risk stratification and guide the timing of interventions for isolated TR.