Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas.
JACC Cardiovasc Imaging. 2020 Jul;13(7):1461-1471. doi: 10.1016/j.jcmg.2020.01.008. Epub 2020 Mar 18.
The aim of this study was to compare echocardiographic methods of determining tricuspid regurgitation (TR) severity against TR regurgitant volume (TR) by cardiovascular magnetic resonance (CMR).
TR is usually assessed using echocardiography, but it is not known how this compares with quantitative measurements of TR severity by CMR.
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 TR 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.
Echocardiographic parameters of TR severity had variable accuracy against TR 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).
Several individual echocardiographic parameters of TR severity have satisfactory accuracy against TR 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.
本研究旨在比较超声心动图方法和心血管磁共振（CMR）测量三尖瓣反流（TR）严重程度的效果，评估 TR 反流量（TRV）。
TR 通常通过超声心动图进行评估，但尚不清楚这与 CMR 定量测量 TR 严重程度的比较如何。
对 337 例患者进行超声心动图和 CMR 比较。超声心动图方法包括射流面积、肝静脉血流、下腔静脉直径、下腔静脉直径随呼吸的变化百分比、右心房收缩末期面积和容积、右心室舒张末期和收缩末期面积和分数面积变化、收缩期瓣口有效面积、三尖瓣反流（TR）采用近端等速表面积法。CMR 测量 TRRV 通过右心室舒张末期和收缩末期容积与肺动脉瓣收缩期血流之间的差值计算得出。
TR 严重程度的超声心动图参数与 CMR 测量的 TR 具有不同的准确性（曲线下面积范围为射流面积/右心房收缩末期面积的 0.58 至肝静脉血流的 0.79）。根据 2017 年美国超声心动图学会标准评估 TR 严重程度的多参数方法与 CMR 测量的 TR 严重程度有 65%的一致性。基于对 CMR 具有更高可行性和准确性的信号的分层方法具有 68%的一致性，不会遗漏 CMR 严重 TR 病例。与 2017 年美国超声心动图学会指南相比，基于分层方法的一致性更高（p = 0.016）。
TR 严重程度的几种超声心动图参数与 CMR 测量的 TR 具有令人满意的准确性。多参数分层方法与 CMR 具有 68%的一致性，当认为 TR 严重程度相差 1 级可接受时，一致性为 100%。
