TRI-SCORE and Right Ventricular Free-Wall Longitudinal Strain for Mortality Risk Stratification After Transcatheter Tricuspid Valve Intervention

Risk stratification after transcatheter tricuspid valve intervention (TTVI) remains challenging, and right ventricular free-wall longitudinal strain (RVFWLS) may complement established clinical assessment. This prospective single-centre cohort study evaluated the prognostic performance of the TRI-SCORE and the incremental value of pre-interventional RVFWLS for all-cause mortality after TTVI. Analyses included 56 patients at 12 months and 54 at 24 months. Discrimination was assessed using receiver operating characteristic analysis, paired DeLong tests, Kaplan–Meier analysis and Cox regression. Eleven patients died within 12 months and sixteen within 24 months. RVFWLS magnitude was lower among 24-month non-survivors than survivors (18.0% [IQR 15.0–23.2] vs. 23.5% [19.0–26.0]; p = 0.010). TRI-SCORE AUCs were 0.778 and 0.746 for 12- and 24-month mortality, respectively. Adding RVFWLS increased the AUCs to 0.806 (ΔAUC 0.028; p = 0.322) and 0.771 (ΔAUC 0.025; p = 0.387), respectively. High TRI-SCORE remained independently associated with mortality at 12 months (HR 6.39, 95% CI 1.29–31.79) and 24 months (HR 5.10, 95% CI 1.55–16.81), whereas RVFWLS was not independently associated. TRI-SCORE provided robust mortality stratification after TTVI. RVFWLS identified greater right ventricular vulnerability among non-survivors, but did not significantly improve discrimination in this cohort.