Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehad585. https://doi.org/10.1093/eurheartj/ehad585 Dr. Julien Dreyfus et al.
Points
- This research compares the impact of surgical or transcatheter tricuspid regurgitation (TR) correction versus conservative management based on the TR clinical stage using the TRI-SCORE in 2,413 patients.
- The TRI-SCORE categorizes patients into low, intermediate, and high risk based on the severity of TR, with 32% in the low category, 33% in the intermediate category, and 35% in the high category.
- Successful TR correction was achieved in 97% of surgical patients and 65% of transcatheter patients, with survival rates inversely related to TRI-SCORE across all groups.
- Patients with low TRI-SCORE benefited significantly from early surgical or transcatheter intervention, leading to improved 2-year survival rates compared to conservative management.
- In the high TRI-SCORE category, no significant survival advantage was observed with intervention, even when limited to patients with successful correction, suggesting that conservative management might be more appropriate in such cases.
Summary
This research paper investigates the impact of tricuspid regurgitation (TR) correction on survival rates. It explores the optimal timing of intervention based on the TR clinical stage assessed using the TRI-SCORE. The study included 2,413 patients with severe isolated functional TR, categorized into conservative management (1,217 patients), isolated tricuspid valve surgery (551 patients), and transcatheter valve repair (645 patients) groups. The primary endpoint was 2-year survival.
The TRI-SCORE, stratifying patients into low (≤3), intermediate (4-5), and high (≥6) categories, revealed that 32% had low scores, 33% had intermediate scores, and 35% had high scores. Surgical and transcatheter interventions successfully corrected 97% and 65% of patients. Survival rates were inversely correlated with TRI-SCORE across all treatment groups (P < 0.0001). In the low TRI-SCORE category, surgical and transcatheter interventions yielded higher survival rates than conservative management (93%, 87%, and 79%, respectively; P = 0.0002). In the intermediate category, overall differences were not significant (80%, 71%, and 71%, respectively; P = 0.13), but the benefit of intervention emerged in patients with successful correction (80%, 81%, and 71%, respectively; P = 0.009). In the high TRI-SCORE category, survival remained similar between groups, even when limited to patients with successful correction (61%, 68%, and 58%, respectively, P = 0.08).
In conclusion, this study highlights that survival rates decline as TRI-SCORE increases, regardless of treatment modality. Early and successful surgical or transcatheter interventions improved 2-year survival in patients with low TRI-SCORE, with some benefits observed in the intermediate group. However, no significant advantage was observed in the high TRI-SCORE category compared to conservative management. These findings provide valuable insights for clinicians in determining the appropriate timing and approach for TR correction in patients with different clinical stages.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad585/7250504
References Dreyfus, J., Galloo, X., Taramasso, M., Heitzinger, G., Benfari, G., Kresoja, K.-P., Juarez-Casso, F., Omran, H., Bohbot, Y., Iliadis, C., Russo, G., Topilsky, Y., Weber, M., Nombela-Franco, L., Sala, A., Eixerés-Esteve, A., Iung, B., Obadia, J.-F., Estevez Loureiro, R., … for the TRIGISTRY investigators. (2023). TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. European Heart Journal, ehad585. https://doi.org/10.1093/eurheartj/ehad585
