Three-dimensional Transthoracic Echocardiographic Evaluation of Tricuspid Regurgitation Severity Using Proximal Isovelocity Surface Area: Comparison With Volumetric Method

BackgroundThe quantification of tricuspid regurgitation(TR) using three-dimensional(3D) proximal isovelocity surface area (PISA)derived effective regurgitant orifice area (EROA) is feasible in functional TR. The aim of our study was to explore thediagnostic accuracy and utility of 3D PISA EROA in a larger population of different etiologies. MethodsOne hundred and seven patients with confirmed TR underwent 2D and 3D transthoracic echocardiography (TTE). 3D PISA EROA was calculatedand EROA derived from 3D regurgitant volume (Rvol) was used as the reference. Results3D PISA EROA showed better correlation in primary TR than in functional TR(r=0.897, P<0.01). 3D PISA EROA differentiated severe TR with comparable accuracy in patients with primary and functional etiology (Z-value 16.506 vs 21.202), but with different cut-offs (0.49cm2vs. 0.41 cm2). The chi-square value for incorporated clinical symptoms, positive echocardiographic results and 3D PISA EROA to grade severe TR was higher than only included clinical symptoms or incorporated clinical symptoms and posotive echocardiographic results (chi-square value 137.233, P <0.01). ConclusionTR quantification using 3D PISA EROA is feasible and accurate under different etiologies. Ithas incremental diagnostic value for evaluating severeTR.