Comparison between multimodality imaging approaches for measurement of the tricuspid annulus in severe tricuspid regurgitation

• Published in: International journal of cardiology 2023-07, Vol.383, p.151-158
• Main Authors: Meng, Hong, Zhao, Xing, Wang, Jian-De, Wan, Lin-Yuan, Shi, Hao, OuYang, Wen-Bin, Pan, Xiang-Bin
• Format: Article
• Language: English
• Subjects: Computed tomography; Cross-Sectional Studies; Echocardiography; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal - methods; Humans; Multimodal Imaging; Retrospective Studies; Tricuspid annulus diameter; Tricuspid regurgitation; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - surgery
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.03.027

Tricuspid valve (TV) sizing is crucial for surgical or interventional procedures planning. Imaging TV is frequently challenging and often requires multimodal imaging techniques. Computed tomography (CT) is the gold standard for sizing. The authors compared measurements of the tricuspid annulus (TA) acquired using echocardiography and CT. Thirty-six patients with severe symptomatic tricuspid regurgitation were included in this retrospective analysis. During mid-diastole, the maximal two-dimensional (2D) TA diameter was directly measured in multiple views using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Three-dimensional (3D) TA size was assessed using cross-sectional long-axis and short-axis diameters, areas, and perimeters measured in the projected plane. The TA diameter was quantified by the perimeter measured on the CT images (CT imaging_indirect) and compared with echocardiography measurements. Tenting height and tenting area were also measured using TTE at mid systole. The long-axis dimensions measured using 3DTEE (3DTEE_direct) best correlated with the TA diameter (CT imaging_indirect) (R = 0.851, P = 0.0001) and the least discrepancies (difference 1.2 ± 2.4 mm, P = 0.012). The TA diameters quantified by the perimeters measured using 3DTEE (3DTEE_indirect) were smaller than the CT values (difference 2.5 ± 2.5 mm, P = 0.0001). The maximal dimensions directly measured by 2DTEE (2DTEE_direct) were modestly correlated with the CT values. Overall, the maximal dimensions by TTE_direct were less reliable than those by CT. TA eccentricity index correlated with the maximal tenting height and area. The patients with severe tricuspid regurgitation had a dilated and circular annulus. The long-axis TA dimensions (3DTEE_direct) were similar to the diameters (CT imaging_indirect). •Sizing of the TV is crucial for planning surgical or interventional procedures.•Echo and CT following a dedicated tricuspid protocol were performed in the patients with severe TR to assess TA diameter.•A dilated and circular tricuspid annulus was present under severe tricuspid regurgitation.•The long-axis dimensions (3DTEE_direct) best correlated with CT values, with the least discrepancies.•The TA diameter (3DTEE_indirect) and the maximal dimension (2DTEE_direct) were smaller than CT values.•The maximal dimension by 2DTTE_direct was overall less reliable compared with CT.