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

Tricuspid regurgitation (TR) is a progressive and underdiagnosed condition associated with poor prognosis. Although the TRI-SCORE is a validated risk model for patients undergoing tricuspid valve surgery, it does not incorporate echocardiographic measures of right ventricular (RV) function or RV-pulmonary artery coupling, which are increasingly recognised as major prognostic determinants.

To evaluate whether integration of simple, widely available echocardiographic indices-tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP), TAPSE/RV end-diastolic area (RVAD) and TAPSE/RV end-systolic area (RVAS)-improves the prognostic performance of the TRI-SCORE in patients with moderate-to-severe TR.

We retrospectively included 93 patients with severe TR, including functional, mixed and primary/Cardiac Implantable Electronic Device (CIED)-related aetiologies treated with medical therapy, surgery or transcatheter edge-to-edge repair. The primary endpoint was all-cause mortality; the secondary endpoint was a composite of mortality or heart failure hospitalisation. Multivariable Cox regression models were used to assess the incremental predictive value of each TAPSE-derived ratio beyond the TRI-SCORE. Optimal thresholds were derived using spline regression and maximally selected rank statistics.

Lower TAPSE/PASP, TAPSE/RVAD and TAPSE/RVAS values were independently associated with worse outcomes. Each parameter significantly enhanced risk discrimination when added to the TRI-SCORE (C-index improved from 0.614 to 0.710 for TAPSE/PASP, 0.685 for TAPSE/RVAD and 0.696 for TAPSE/RVAS; all p<0.001). Prognostically relevant cut-offs were identified at 0.44, 0.80 and 1.3, respectively.

Simple echocardiographic indices of RV function provide substantial incremental prognostic value when combined with the TRI-SCORE and may improve risk stratification and timing of intervention in isolated TR.