Combined TRI-Score and pulmonary vascular resistance enhance 12-month mortality prediction after transcatheter tricuspid valve intervention
J Schlegl, C Edlinger, M Bannehr, T Kueken, M Lichtenauer, A Krutz, V Paar, M Neuss, A Haase Fielitz, C ButterAbstract
Background
Interventional therapies for tricuspid regurgitation (TR) are rapidly advancing; however, identifying patients who derive a survival benefit remains difficult. The TRI-Score has become the most established clinical risk score for mortality prediction after transcatheter tricuspid valve intervention (TTVI), outperforming alternative scoring systems. Although it integrates key clinical and echocardiographic markers of systemic congestion and end-organ dysfunction, invasive right-heart hemodynamics are not included. Parameters such as pulmonary vascular resistance (PVR) may better capture right-sided circulatory burden and thereby refine risk stratification. This study investigated whether adding invasively assessed PVR to the TRI-Score improves prediction of 12-month mortality following TTVI.
Methods
In this single-center prospective cohort, 118 patients with severe TR (≥3 according to Hahn) underwent either edge-to-edge repair (81,3%) or minimally invasive tricuspid valve replacement (18,7 %). Both the TRI-Score and PVR were obtained prior to intervention. Patients were followed for 12 months after the procedure. The results of the TRI-score were sorted into low-risk and medium-risk versus high-risk categories according to the calculator. A Kaplan–Meier analysis was performed to illustrate survival rates between TRI-Score risk categories. Receiver-operating-characteristic analyses (ROC) with area-under-the-curve (AUC) calculation were conducted to assess their separate and combined predictive performance for all-cause mortality at 12 months.
Results
Baseline characteristics are summarized in Table 1. Mean age was 81 ± 6.6 years, and 44.9% of patients were male. Twelve-month all-cause mortality was 18.6%. The TRI-Score demonstrated good prognostic discrimination for 12-months mortality (AUC = 0.76, 95% CI 0.65–0.88, p < 0.001), Figure 1.A. The Kaplan–Meier analysis revealed significantly better survival for patients in the low- and intermediate-risk TRI categories compared with high-risk TRI-Score categories (log rank p < 0.001), Figure 2. Among right-heart hemodynamic parameters, both RA and RV pressure showed prognostic relevance for 12-months mortality (Figure 1.B). In contrast, PVR alone demonstrated limited and statistically non-significant discriminatory ability (AUC 0.62, 95% CI 0.48–0.76; p = 0.140). However, the combination of the TRI-Score and PVR yielded the highest predictive performance (AUC = 0.81, 95% CI 0.69–0.93, p < 0.001), Figure 1.C.
Conclusion
The TRI-Score provides reliable risk stratification for 12-month all-cause mortality after TTVI. Its prognostic performance is enhanced by the addition of PVR.For image description, please refer to the figure legend and surrounding text.Figures 1.A), 1. B), 1. C), 2For image description, please refer to the figure legend and surrounding text.