Combining MELD-XI score and hemodynamic parameters enhances short-term prognostic value in patients undergoing transcatheter tricuspid valve interventions

Hepatorenal dysfunction is a key prognostic factor in patients with symptomatic tricuspid valve regurgitation (TR). This study evaluated the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD), the modified MELD-XI score, and right heart hemodynamic parameters in patients undergoing transcatheter tricuspid valve interventions (TTVI).

This prospective, single-center cohort study included patients undergoing edge-to-edge or heterotopic tricuspid valve repair. The MELD and MELD-XI scores were calculated using creatinine, bilirubin and the international normalized ratio (INR). All patients underwent right heart catheterization. The predictive value of MELD/MELD-XI scores and hemodynamic parameters, individually and combined, was assessed for a composite endpoint of 3‑month mortality or rehospitalization using receiver operating characteristics (ROC) analysis.

In this study 36 patients (mean age 80.2 ± 5.9 years; 33.3% male) were analyzed. Rehospitalization occurred in 25% and the 3‑month mortality was 11%. Both MELD-XI (area under the curve, AUC 0.96, 95% confidence interval, CI 0.88–1.00, p = 0.01) and MELD score (AUC 0.91, 95% CI 0.78–1.00, p = 0.023) showed excellent predictive values for mortality. The preinterventional MELD-XI score, right ventricular (RV) pressure (AUC 0.82, 95% CI 0.61–1.00, p = 0.029), right atrial (RA) pressure (AUC 0.86, 95% CI 0.70–1.00, p = 0.015) and pulmonary artery (PA) pressure (AUC 0.82, 95% CI 0.65–0.98, p = 0.029) were predictive for the combined endpoint. The predictive value of the MELD-XI for the combined endpoint was further improved when integrating PA pressure, RA pressure, and RV pressure in the model (AUC 0.91, 95% CI 0.77–1.00, p = 0.002).

This pilot study identified MELD-XI score as a potential risk score for 3‑month mortality after TTVI. Its prognostic value for the combined endpoint was increased after adding invasive hemodynamic parameters.