Application of the TRI-SCORE to predict long-term mortality in acute heart failure patients with moderate-to-severe tricuspid regurgitation.

Abstract

Introduction: Moderate‑to‑severe tricuspid regurgitation (TR) in the setting of acute heart failure (AHF) has been found to be associated with worse clinical outcomes. Recently, the TRI‑SCORE model was developed to predict clinical outcomes after isolated tricuspid surgery.

Objectives: Our aim was to determine whether this score could aid in risk stratification of AHF patients with moderate‑to‑severe TR.

Patients and methods: A total of 233 hospitalized patients with AHF and moderate‑to‑severe TR were included. We calculated the TRI‑SCORE for each patient, including the following parameters: age at least 70 years, New York Heart Association class at least III, right‑sided HF signs, daily furosemide dose at least 125 mg, glomerular filtration rate below 30 ml/min/1.73 m2, elevated total bilirubin concentration, left ventricular ejection fraction below 60%, and moderate-to-severe right ventricular dysfunction. The primary end point was all‑cause mortality during follow‑up.

Results: The median (interquartile range [IQR]) age was 74 (65-84) years, 129 patients (55.4%) were women. During median (IQR) follow‑up of 8 (2-21) months, 135 patients (57.9%) reached the primary end point. The patients with the primary end point had a higher median (IQR) TRI‑SCORE value than those without (8 [6-9] vs 6 [4-7]; P <0.001). The multivariable Cox regression analysis showed that a 1‑point increase in the TRI‑SCORE was a significant indicator of all‑cause mortality (hazard ratio, 1.25; 95% CI, 1.14-1.38; P <0.001). The Kaplan-Meier analysis showed early divergence of low (0-3), intermediate (4-5), and high (≥6) TRI‑SCORE curves (log-rank; P <0.001).

Conclusions: The AHF patients with moderate‑to‑severe TR have a poor prognosis during follow‑up. TRI‑SCORE can predict all‑cause mortality in these patients.