Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.
R, M., M, B., EK, D.O., R, V., S, G., E, B., P, P., J, S., M, P., & M, V. (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
R M, M B, EK DO, R V, S G, E B, et al. Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.. Open heart. 2026; doi: 10.1136/openhrt-2026-003981
R M, M B, EK DO, et al. Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.[J]. Open heart. 2026. DOI: 10.1136/openhrt-2026-003981.
@article{r2026,
author = {Mistrulli R and Beles M and De Oliveira EK and Vrenozaj R and Gharehdaghi S and Barbato E and Paolisso P and Spapen J and Penicka M and Vanderheyden M},
title = {Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation.},
journal = {Open heart},
year = {2026},
doi = {10.1136/openhrt-2026-003981},
note = {PMID: 42425726},
}
TY - JOUR AU - Mistrulli R AU - Beles M AU - De Oliveira EK AU - Vrenozaj R AU - Gharehdaghi S AU - Barbato E AU - Paolisso P AU - Spapen J AU - Penicka M AU - Vanderheyden M TI - Integrating RV-PA coupling and geometry-based indices into the TRI-SCORE improves prognostic assessment in tricuspid regurgitation. T2 - Open heart PY - 2026 DO - 10.1136/openhrt-2026-003981 AN - PMID:42425726 ER -
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 recognised as major prognostic determinants. OBJECTIVES: To evaluate whether integration of simple, widely available echocardiographic indices-tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (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 severe TR, including functional, mixed and primary/Cardiac Implantable Electronic Device (CIED)-related aetiologies 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 hospitalisation. 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). Prognostically relevant cut-offs were identified at 0.44, 0.80 and 1.3, respectively. 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.