TRIVO score: a new tool for predicting outcome in patients with secondary tricuspid regurgitation.

Abstract Background Predicting outcomes in patients with significant secondary tricuspid regurgitation (STR) is extremely challenging. Purpose This study sought to develop and validate the TRIVO-SCORE, utilizing advanced echocardiographic parameters, for predicting hospitalization for heart failure (HF) and mortality in moderate and severe STR patients. Methods We retrospectively studied 504 consecutive STR outpatients (mean age 74 ± 13 years, 44% men), randomly divided into derivation (49%) and validation (51%) cohorts. The primary endpoint included all-cause death and/or heart failure HF hospitalization, whereas the secondary endpoint focused on HF hospitalization or all-cause death. Score discrimination was assessed using time-dependent area under the receiver operating characteristic curve (AUROC), and calibration was evaluated via the Hosmer-Lemeshow goodness-of-fit test. In a subset of patients (162/504, 29%) with severe STR and comprehensive clinical, laboratory, and echocardiographic data, we compared TRIVO-SCORE with TRI-SCORE and TRIO-SCORE. Results After Multivariable Cox Regression Analysis, four variables were incorporated into the final model: moderate to severe chronic kidney disease (CKD, GFR <30 mL/min), effective Right Ventricular Ejection Fraction (eRVEF <20%), right Ventricular free wall longitudinal strain/pulmonary artery systolic pressure (RVFWLS/PASP) <0.48, and effective regurgitant orifice area (EROA) >0.41cm². The final score ranged from 0 to a maximum of 5 points. The TRIVO-SCORE demonstrated satisfactory performance in both the derivation cohort (AUROC 0.78, 95% CI 0.73-0.84) and the validation cohort (AUROC 0.71, 95% CI: 0.65-0.77) at 2-year. TRIVO-SCORE accurately predicted separate endpoints for HF hospitalization or mortality. Per each point of TRIVO-SCORE, the risk of experiencing the composite endpoint increased by 1.5 times (HR 1.55 [95% CI 1.35–1.80], p<0.001, for each stage increase). This progressive increase in risk persisted when stratifying the population into atrial and ventricular STR. The discrimination and calibration for mortality prediction were superior to those of TRI-SCORE (1) (AUROC 0.61) and TRIO-SCORE (2) (AUROC 0.57). Conclusions The TRIVO-SCORE, integrating both clinical and advanced echocardiographic variables, proved to be a robust tool for enhancing risk stratification in patients with moderate to severe STR, providing a stronger association with outcomes than previously validated risk scores.