Author + information
- Received October 24, 2019
- Revision received December 29, 2019
- Accepted January 3, 2020
- Published online July 6, 2020.
- Yang Zhan, MDa,
- Alpana Senapati, DOa,
- Pimprapa Vejpongsa, MDa,
- Jiaqiong Xu, PhDa,b,
- Dipan J. Shah, MDa and
- Sherif F. Nagueh, MDa,∗ ()
- aDepartment of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- bCenter for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
- ↵∗Address for correspondence:
Dr. Sherif F. Nagueh, Methodist DeBakey Heart & Vascular Center, 6550 Fannin, SM-677, Houston, Texas 77030.
Objectives The aim of this study was to compare echocardiographic methods of determining tricuspid regurgitation (TR) severity against TR regurgitant volume (TRRV) by cardiovascular magnetic resonance (CMR).
Background TR is usually assessed using echocardiography, but it is not known how this compares with quantitative measurements of TR severity by CMR.
Methods Echocardiographic and CMR methods were compared in 337 patients. Echocardiographic methods included jet size, hepatic vein flow, inferior vena cava diameter, percentage change in inferior vena cava diameter with inspiration, right atrial end-systolic area and volume, right ventricular end-diastolic and end-systolic areas and fractional area change, vena contracta diameter, effective regurgitant orifice area, and TRRV using the proximal isovelocity surface area method. TRRV by CMR was calculated as the difference between right ventricular end-diastolic and end-systolic volumes and systolic flow through the pulmonic valve.
Results Echocardiographic parameters of TR severity had variable accuracy against TRRV by CMR (area under the curve range 0.58 for jet area/right atrial end-systolic area to 0.79 for hepatic vein flow). A multiparametric approach to assessing TR severity according to the 2017 American Society of Echocardiography criteria had 65% agreement with TR severity by CMR. A hierarchal approach based on signals with higher feasibility and accuracy against CMR had 68% agreement, without missing cases of severe TR by CMR. Agreement with CMR by the hierarchal approach was higher than that by the 2017 American Society of Echocardiography guidelines (p = 0.016).
Conclusions Several individual echocardiographic parameters of TR severity have satisfactory accuracy against TRRV by CMR. A multiparametric hierarchal approach resulted in 68% agreement with CMR and 100% agreement when a 1-grade difference in TR severity is considered acceptable.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received October 24, 2019.
- Revision received December 29, 2019.
- Accepted January 3, 2020.
- 2020 American College of Cardiology Foundation
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