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.
The TRI-SCORE alone showed modest prognostic discrimination for all-cause mortality in patients with moderate-to-severe tricuspid regurgitation.
Adding TAPSE/PASP to the TRI-SCORE significantly improved prognostic discrimination for all-cause mortality.
Adding TAPSE/RVAD (TAPSE divided by RV end-diastolic area) to the TRI-SCORE significantly improved prognostic discrimination.
Adding TAPSE/RVAS (TAPSE divided by RV end-systolic area) to the TRI-SCORE significantly improved prognostic discrimination.
Lower values of all three TAPSE-derived ratios were independently associated with worse outcomes in patients with severe tricuspid regurgitation.
The TRI-SCORE, a validated risk model for tricuspid valve surgery, does not incorporate echocardiographic measures of RV function or RV-pulmonary artery coupling.
This research examined whether adding simple heart ultrasound measurements to an existing risk score (called the TRI-SCORE) could better predict outcomes for patients with severe tricuspid regurgitation — a condition where the heart's tricuspid valve leaks blood backward. The study looked at 93 patients and tracked deaths and hospitalizations for heart failure. The researchers tested three measurements derived from how well the right side of the heart pumps relative to the pressure it faces and its size, all calculated using a standard measurement called TAPSE (tricuspid annular plane systolic excursion). The study found that the TRI-SCORE alone had only modest ability to predict who would die (C-index of 0.614, where 1.0 would be perfect prediction). However, when any of the three new measurements were added to the TRI-SCORE, the predictive ability improved substantially — with the best improvement seen when TAPSE/PASP (a measure of how the right heart couples with lung artery pressure) was added, raising the C-index to 0.710. Specific threshold values were identified for each measurement that could help classify patients as higher or lower risk: 0.44 for TAPSE/PASP, 0.80 for TAPSE/RVAD, and 1.3 for TAPSE/RVAS. This research suggests that including these easily obtainable ultrasound measurements alongside the existing TRI-SCORE could help doctors better identify which patients with tricuspid regurgitation are at highest risk of death or hospitalization, potentially improving decisions about when to intervene with surgery or catheter-based procedures. These measurements are already available in standard cardiac ultrasound examinations, meaning they could be incorporated into clinical practice without requiring additional specialized testing.
Mistrulli R, Beles M, De Oliveira E, Vrenozaj R, Gharehdaghi S, Barbato E, et al.. (2026). Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.. Open heart. https://doi.org/10.1136/openhrt-2026-003981