Tricuspid annulus deformation indices predicting severe functional tricuspid regurgitation: 3D echocardiographic study

Abstract

Introduction In these past few years tricuspid valve (TV) got its appreciation due to the latest focus of complications driven by tricuspid regurgitation (TR). Even though severe TR may require surgical repair, precise analyses performed by 3D echocardiographic tools to determine severe functional TR (FTR) are scarce. Aim To determine the accuracy of 3D echo-derived TV parameters in predicting severe FTR. Methods Prospective observational cohort study enrolled 90 patients (pts) with functional moderate (70%) or severe (30%) TR. Pts with FTR of various aetiologies (due to left-sided valvular heart disease, pulmonary arterial hypertension [invasively measured pulmonary capillary wedge pressure <15 mmHg]) were included in this study. Pts with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. TR severity was measured quantitatively: severe FTR was defined by 2 parameters: vena contracta ≥7 mm and TR effective regurgitant orifice area ≥40 mm2. The transthoracic echocardiography was performed and included the following 2D and 3D-derived TV parameters: the systolic and diastolic 4-chambers (septal – lateral), 2-chambers (anterior-posterior), major and minor axis TA diameters, TA area, perimeter, leaflet tenting height and volume. The 3D TV analysis was made using the 4D Auto TVQ quantification software package. Receiver Operating Characteristic (ROC) curves, area under the curve (AUC), specificity and sensitivity were analysed. Results Study cohort included 66% females; mean age was 65±11 years. The results of the ROC analysis are shown in Table 1. Of all TA 3D parameters, septal-lateral systolic (AUC 0.859) and diastolic (AUC 0.840) diameter, major axis systolic (AUC 0.816) and diastolic (AUC 0.810) diameter, as well as leaflet tenting volume (AUC 0.769) have the highest predictive value for severe FTR. 3D TA analysis provides 75–88% sensitivity for defying pts with severe FTR. Meanwhile, septal-lateral diameter, major axis diameter and annulus perimeter are the most specific to determine severe FTR. 2D echo-derived TA 4-chamber diastolic diameter index has a lower predictive value with worse sensitivity and specificity, compared to 3D parameters. Conclusions Analysis of three-dimensional echocardiographic parameters is an accurate method, suggesting that dilation of tricuspid annulus is a precise measure for identifying patients with severe FTR. Funding Acknowledgement Type of funding sources: None.