Open heart · 2026
Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.
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Mistrulli Raffaella, Beles Monika, De Oliveira Elayne Kelen, Vrenozaj Rosie, Gharehdaghi Sara, Barbato Emanuele, Paolisso Pasquale, Spapen Jerrold, Penicka Martin, Vanderheyden Marc, Rosseel Liesbeth, Praet Frank V, Hermans Hadewich, Van Camp Guy
Аннотация
BACKGROUND: 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.
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.