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

Background: 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. Methods: 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. Results: 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). Conclusion: 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.