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

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 recognized as major prognostic determinants. Objectives To evaluate whether integration of simple, widely available echocardiographic indices—TAPSE/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 isolated moderate-to-severe TR 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 hospitalization. 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) (figure 1). Prognostically relevant cut-offs were identified at 0.44, 0.80, and 1.3, respectivel (figure 2). 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.tr--graphical--abstract.jpegcut-off--tapse.jpeg