Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is an important therapeutic option for patients with severe tricuspid regurgitation (TR). The EuroTR score recently emerged, deducted specifically from a real-world T-TEER-registry. Compared to previous models, it places greater emphasis on right heart morphology and function. However, external validation of the EuroTR score has not been performed yet.
The present study assesses the predictive performance of the EuroTR-Score and compares it with previous, surgically derived risk scores.
Methods: 353 patients undergoing T-TEER at Ulm University Heart Center from 2016 until 2024 were included in this analysis. Patients were stratified according to the EuroTR score into three risk categories: low risk (0–25th percentile), intermediate risk (25th–95th percentile), and high risk (≥95th percentile).
Results: Median EuroTR score was 53.3 (IQR 29–74.6). 70 patients (19.8%) were categorized into the low-risk group, 266 (75.4%) into the intermediate-risk group, and 17 (14.8%) into the high-risk group. The high-risk group had more severe comorbidities than the intermediate- and low-risk group including right heart failure sings (82.4, 42.6 and 32.9%, p < 0.001) and impaired renal funcion (median GFR 29.0, 36.0 and 61.0 ml/min, p < 0.001). Procedural success (post-procedural TR ≤ II) was achieved more often in the lower risk groups (90%, 83,3% and 70,6%, respectively; p < 0.001).
One-year mortality was 2.9% in the low-risk group, 12.8% in the intermediate-risk group, and 29.4% among high-risk patients (p < 0.001). Corresponding hospitalization for heart failure (HFH) rates reached 7.8%, 28.8%, and 60.0% (p < 0.001). Predictive performance of the EuroTR score for one-year mortality (Area under the receiver operating characteristics curve (AUROC) 72.2%, 95% confidence interval (CI): 64.7–79.8) was comparable to the TRI-SCORE (76.2%, 95% CI: 69.1–83.4). However, it outperformed both the STS-Tricuspid score (AUROC 68.4%, 95% CI 59.7–77.0) and the EuroSCORE II (AUROC 67,7%, 95% CI: 59.6–75.8). Regarding HFH within 1 year, EuroTR score showed superior discriminatory ability compared to the other scores (AUROC 67.5%, 95% CI: 61.0–74.0; TRI-SCORE: AUROC 54.5%, 95% CI: 47.1–62.0; STS-Tricuspid score: AUROC 60.1%, 95% CI: 53.0–67.2; EuroSCORE II: AUROC: 58.2%, 95% CI: 51.1–65.2).
The EuroTR Score categorized mortality risk similarly to the TRI-SCORE (absolute net reclassification index (NRI): 1.3%) and outperformed the EuroSCORE II (NRI 15.5%), however it was less accurate than the STS-Tricuspid score (NRI -19.2%). Regarding categorization of 1-year HFH risk, the EuroTR score outperformed the TRI-SCORE (NRI 15,2%) and the EuroSCORE II (NRI 14.6%), however it was slightly less accurate that the STS-Tricuspid score (NRI -3.3%).
Conclusion: The novel, TEER-specific EuroTR score predicts one-year mortality after T-TEER similarly to the TRI-SCORE. The EuroTR score also predicts one-year HFH with acceptable accuracy. Notably, risk categorization by the EuroTR score is less precise than provided by the STS-Tricuspid score.
