Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study

Abstract

Background: Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. Methods: This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. Results: A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. Conclusions: These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies.

Edge-to-Edge Repair for Tricuspid Valve Regurgitation. Preliminary Echo-Data and Clinical Implications from the Tricuspid Regurgitation IMAging (TRIMA) Study

“…This prospective, single-arm study, conducted at the University Campus Bio-Medico of Rome, Italy, screened 27 consecutive symptomatic patients referred with the diagnosis of at least severe TR from June 2020 to March 2022. The anatomical feasibility was established according to a detailed transoesophageal echocardiogram (TEE) and a dedicated computerised tomography (CT) for the right cardiac chamber [ 13 ]. Patients with the following criteria were included in the study: symptomatic heart failure, at least severe TR, adequate transoesophageal windows, suitable anatomy for leaflet grasping (sufficient tissue for grasping, leaflet lengths < 7 mm and primary TR with prolapse or secondary TR with normal appearing leaflet mobility), normal to moderately reduced RV function, systolic PAP < 60 mmHg, absence of significant valvular calcifications and active malignancy.…”

Tricuspid Valve Geometrical Changes in Patients with Functional Tricuspid Regurgitation: Insights from a CT Scan Analysis Focusing on Commissures

“…The entire patient population was divided into two groups according to the presence or not of severe TR. Specifically, 43 patients with symptomatic severe TR, referred to our institute for TTVI consideration, were prospectively enrolled as part of the previously published TRIMA (Tricuspid Regurgitation IMAging) study (TR ≥ 3+ group) [14]. They were retrospectively compared with 43 patients who underwent cardiac CT scanning for triple rule-out for acute coronary artery disease, aortic dissection, or pulmonary embolism when clinically indicated (control group) [16][17][18].…”

“…Based on the patient body mass index (BMI) and glomerular filtration rate (GFR), the tube voltage varied for each examination from 100 to 120 kV. Ionic contrast agent (Omnipaque 350 mg I/mL, GE Healthcare, USA), adjusted for BMI and GFR, was infused into the antecubital vein according to two different protocols [14,17]. In the TR ≥ 3+ population, a biphasic contrast protocol was infused-60-80 mL mixture of 80%/20% contrast/saline, with a flow rate of 4.0-5.0 mL/s, followed by a 50 mL of saline-whereas patients for the triple rule-out group (control group) received a triphasic contrast protocol-70-80 mL of contrast with a flow rate of 5.0-7.0 mL/s followed by a 50 mL mixture of 50%/50% contrast/saline with a flow rate of 4.0 mL/s and by a 30 mL of saline.…”

“…Each TTVI requires specific imaging protocols to evaluate the anatomical feasibility and predict outcomes after the procedure. Likewise, different CT parameters have been tested so far in order to support the screening process and the development of novel transcatheter therapies [11][12][13][14][15].…”

Percutaneous Atrio-Ventricular Valve Interventions: Contemporary Advances and Remaining Challenges

“…Comprehensive imaging is expected to play a key role in the planning and periprocedural assistance of percutaneous TR repair [ 17 , 18 ]. In the TRIMA (Tricuspid Regurgitation Imaging) study, Cammalleri et al assessed the geometrical characteristics of the tricuspid valve complex using novel computed tomography (CT) parameters [ 19 ]. In this small prospective study, patients with severe TR underwent a cardiac CT study dedicated to the right chambers.…”