P764 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation

Abstract Background According to current EACVI guidelines, right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified. Purpose Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR. Methods 302 patients (59 ± 13 years, 54 % women) with functional TR underwent two- and three-dimensional echocardiography. Using the nonparameteric Variable Importance (VIMP) software package, we assessed the relative importance of 6 differerent parameters (indexed by body surface area) to identify severe TR: 3D RV end diastolic volume (RVEDVi), 3D RV end systolic volume (RVESVi), 3D RA max volume (3DRAi), 2D RA systolic volume (3DRAi), 2D RV basal diameter (2DRVdi) and 2D TAi measured in the apical 4-chamber view. Results According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= -0.0011 and RVESVi= -0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2D TAi (VIMP= 0.004) showed good predictive ability. Conclusions Among the various right heart structures undergoing remodeling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR.

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47 Identification of threshold values to define right chamber enlargement consistent with severe tricuspid regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.009 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Previtero ◽

D Bottigliengo ◽

A C Guta ◽

R C Ochoa-Jimenez ◽

S Figliozzi ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Threshold Value ◽

Threshold Values ◽

Basal Diameter ◽

Severe Tricuspid Regurgitation ◽

Systolic Volume ◽

End Diastolic Volume ◽

Chamber View ◽

2D Echocardiography ◽

The Right

Abstract Background Right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation, are listed among the supportive signs to grade severe tricuspid regurgitation (TR) according to current EACVI and ESC guidelines. However, at present, there is no cut-off value to define RV, RA and TA dilatation associated to severe TR. Purpose Accordingly, we sought to identify the threshold values of RV, RA and TA size associated to severe TR. Methods 302 patients (59 ± 13 years, 54 % women) with functional TR underwent three- (3D) and two-dimensional (2D) echocardiography to obtain: 3D RV end diastolic volume (RVEDVi) indexed for body surface area (BSA), 3D RV end systolic volume indexed for BSA (RVESVi), 3D RA max volume indexed for BSA (3DRAi), 2D RA systolic volume indexed for BSA (3DRAi), 2D RV basal diameter (2DRVd), 2D RV basal diameter indexed for BSA (2DRVdi), 2D TA measured in the apical 4-chamber view and 2D TA measured in the apical 4-chamber view indexed for BSA. To identify the threshold values of the parameters that discriminate patients with right chamber enlargement associated to severe TR, we selected the probability which returns the best sum of sensitivity and specificity on the ROC curve of the model. Results According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. As shown in Figure, 3DRAi > 45 ml/m2 and 2DRAi > 45 ml/m2 identified patients with RA enlargement associated to severe TR. RVEDVi and RVESVi did not show any predictive value for severe TR. Conversely, 2DRVd > 52 mm (or >30 mm/m2) was associated to severe TR. 2DTA > 42 mm ( or >24 mm/m2) was the selected threshold value for TA dilatation. Conclusions Our study provided the threshold values to define the right chamber and TA dilatation associated to severe TR. Implementation of those values in current guidelines can help clinicians to improve their accuracy to identify patients with severe TR. Abstract 47 Figure.

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Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-019-01705-7 ◽

2019 ◽

Vol 36 (2) ◽

pp. 257-268

Author(s):

Yue Zhong ◽

Wenjuan Bai ◽

Hui Wang ◽

Hong Tang ◽

Li Rao

Keyword(s):

Mitral Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Disease ◽

Three Dimensional ◽

Tricuspid Annuloplasty ◽

Functional Tricuspid Regurgitation ◽

Dimensional Echocardiography ◽

One Year ◽

Three Dimensional Echocardiography

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Heart valve disease: tricuspid valve disease

10.1093/med/9780198726012.003.0037 ◽

2016 ◽

Author(s):

Denisa Muraru ◽

Ashraf M. Anwar ◽

Jae-Kwan Song

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Imaging Modality ◽

Three Dimensional ◽

Valve Disease ◽

Heart Valve Disease ◽

Functional Tricuspid Regurgitation ◽

Valve Pathology ◽

Three Dimensional Echocardiography ◽

The Right

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.

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Tricuspid valve geometry and right heart remodelling: insights into the mechanism of atrial functional tricuspid regurgitation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa194 ◽

2020 ◽

Vol 21 (10) ◽

pp. 1068-1078 ◽

Cited By ~ 2

Author(s):

Hiroto Utsunomiya ◽

Yu Harada ◽

Hitoshi Susawa ◽

Yusuke Ueda ◽

Kanako Izumi ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Three Dimensional ◽

Volume Ratio ◽

Right Atrial ◽

Right Heart ◽

Systolic Volume ◽

Functional Tricuspid Regurgitation ◽

End Systolic Volume ◽

Tip Position

Abstract Aims We sought to investigate tricuspid valve (TV) geometry and right heart remodelling in atrial functional tricuspid regurgitation (AF-TR) as compared with ventricular functional TR with sinus rhythm (VF-TR). Methods and results Transoesophageal 3D echocardiography datasets of the TV and right ventricle were acquired in 51 symptomatic patients with severe TR (AF-TR, n = 23; VF-TR, n = 28). Three-dimensional right ventricular (RV) endocardial surfaces were reconstructed throughout the cardiac cycle and then postprocessed using semiautomated integration and segmentation software to calculate position of papillary muscle (PM) tips. Compared with VF-TR, AF-TR had more dilated and posteriorly displaced annulus and less leaflet tethering angles with more prominent right atrium and smaller RV end-systolic volume. On the XY (annular) plane, the centre of annulus was getting closer towards the anterior and posterior PM tips and was going away from the medial PM tip caused by prominent annular dilatation in AF-TR. On the Z-axis, the position of each PM tip in AF-TR was not so much displaced apically as that in VF-TR. Multiple linear regression analyses revealed that right atrial volume and right atrial/RV end-systolic volume ratio were determinants of annular area and orientation in AF-TR, respectively (both P < 0.001). Additionally, the posteromedial-directed component of posterior PM tip position and the apically directed component of the position of all three PM tips were independently associated with TV tethering angles of each leaflet in AF-TR (all P < 0.02). Conclusion Right heart remodelling and its association with 3D TV geometry differ entirely between AF-TR and VF-TR, which may offer distinctive therapeutic implication.

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