Incremental Prognostic Value of Tricuspid Annular Dilatation Over the Society of Thoracic Surgeons (STS) Score - European Medical Journal

Incremental Prognostic Value of Tricuspid Annular Dilatation Over the Society of Thoracic Surgeons (STS) Score

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EMJ Cardiology 8.1 2020 Feature Image
*Simon Deseive,1,2 Julius Steffen,1 Markus Beckmann,1 Julinda Mehilli,1,2 Hans Theiss,1,2 Daniel Braun,1,2 Christian Hagl,3 Steffen Massberg,1,2 Jörg Hausleiter1,2

Prof Mehilli has received an institutional research grant from Boston Scientific; lecture fees from Edwards Lifesciences, Medtronic, Biotronik, Terumo, Boston Scientific, BMS, and AstraZeneca. Prof Hausleiter has received speaker honoraria, research support, and serves on the advisory board for Abbott Vascular and Edwards Lifesciences. Dr Braun has received speaker honoraria from Abbott Vascular. The remaining authors report no conflicts of interest.

EMJ Cardiol. ;8[1]:50-51. Abstract Review No. AR4.
Aortic stenosis, aortic valve intervention, Society of Thoracic Surgeons (STS) score, transcatheter aortic valve replacement (TAVR), tricuspid annular dilatation (TAD).

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Transcatheter aortic valve replacement (TAVR) is the treatment of choice in many patients with severe aortic stenosis. The Society of Thoracic Surgeons (STS) score is a well-established risk score to estimate morbidity, mortality, and procedural risks of patients undergoing TAVR. However, tricuspid annular dilatation (TAD), which is an increasingly recognised pathology associated with increased mortality, is not implemented in the STS score. The purpose of this analysis was to investigate the incremental prognostic value of TAD over the STS score.


The maximal septal-lateral diameter of the tricuspid annulus was measured in 923 patients on three-dimensional multidetector CT datasets. A cut-off of 23 mm/m² body-surface area was revealed by receiver-operating curve statistics and used to define TAD in a previous analysis (data accepted for publication). Incremental prognostic information was tested with C-index statistics and continuous net reclassification improvement. Patients were followed for 2 years and all-cause mortality was defined as the study endpoint.


Of the 923 patients included in this analysis, TAD was found in 370 patients (40%). Patients with TAD had a significantly higher mortality (hazard ratio: 2.18; 95% confidence interval [CI]: 1.71–2.78; p<0.001).

The mean STS score in the investigated patient cohort was 5.6±5.0. TAD provided incremental prognostic information over the STS score when assessed with C-index statistics (a rise from 0.63 to 0.66; p<0.01) or continuous net reclassification improvement (0.209; 95% CI: 0.127–0.292; p<0.001). Estimated survival rates at 2 years were 88.2% (95% CI: 84.5–92.1) in patients with a low STS score (<4) and no TAD and 57.5% (95% CI: 51.1–64.7) in patients with a high STS score (>4) and TAD. Estimated survival rates in patients with a low STS score and TAD and patients with a high STS score and no TAD were similar (75.8%; 95% CI: 68.9–83.5; versus 74.8%; 95% CI: 69.2–80.7, respectively). Kaplan–Meier curves are shown in Figure 1.

Figure 1: Survival stratified of tricuspid dilation and Society of Thoracic Surgeons (STS) score.
The survival of patients after a transcatheter aortic valve replacement procedure, stratified for Society of Thoracic Surgeons (STS) score using a cut-off of 4 and tricuspid annular dilatation.
NRI: net reclassification improvement; STS: Society of Thoracic Surgeons; TAD: tricuspid annular dilatation.


TAD is a common entity in patients undergoing TAVR for severe aortic stenosis. It is associated with significantly higher mortality and provides incremental prognostic information over the STS score.

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