Comparison of Echocardiographic Assessment of Tricuspid Regurgitation Against Cardiovascular Magnetic Resonance.

OBJECTIVES

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).

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 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.

RESULTS

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).

CONCLUSIONS

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.