Buffle Eric, de Marchi Stefano, Mousseaux Elie, Soulat Gilles
Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, 75015, France.
Bern University Hospital, Bern, 3010, Switzerland.
Int J Cardiovasc Imaging. 2025 Jul 18. doi: 10.1007/s10554-025-03459-x.
In this systematic review, we aimed to analyze the methods and results of studies dedicated for quantifying tricuspid regurgitation (TR) with cardiac magnetic resonance (CMR), the concordance between echocardiography and CMR, the prognostic value and the reproducibility of CMR in patients with TR. Published studies on MEDLINE were included using search terms on TR and CMR until June 2024. Out of the 1108 screened articles, 19 studies fulfilled our inclusion criteria. The 2 most commonly used methods were the indirect method which uses 2D-phase contrast (2D-indirect) and the challenging measurement of right ventricular stroke volume. It was used in larger studies with higher proportion of patients with severe TR. The direct method, which uses 4D-phase contrast (4D-direct), has been mainly used in methodological studies with a low proportion of patients with severe TR. 4 studies comparing CMR with echocardiography showed poor severity agreement. In 6 studies assessing the prognostic value of CMR, TR evaluation with tricuspid regurgitant volume (RVol) or regurgitation fraction (RF) yielded a strong prognostic value although right ventricular ejection fraction was the most consistent prognostic predictor. There was very good inter-/intra-observer variability in 8 studies. No study with inter-examination evaluation was found. An independent reference method to compare different CMR measurement methods is still lacking. In conclusion, CMR might play a major role in the evaluation of patients with TR by using 2D-indirect method indices such as RVol and RF for TR quantification and prognosis, but definitive outcome studies using 4D-direct method as a basis for treatment of TR are lacking but needed.
在本系统评价中，我们旨在分析专门用于通过心脏磁共振成像（CMR）定量三尖瓣反流（TR）的研究方法和结果、超声心动图与CMR之间的一致性、CMR在TR患者中的预后价值和可重复性。使用关于TR和CMR的检索词纳入截至2024年6月在MEDLINE上发表的研究。在1108篇筛选的文章中，19项研究符合我们的纳入标准。两种最常用的方法是使用二维相位对比的间接方法（二维间接法）和具有挑战性的右心室每搏量测量。它用于较大规模的研究，其中重度TR患者比例较高。使用四维相位对比的直接方法（四维直接法）主要用于重度TR患者比例较低的方法学研究。4项比较CMR与超声心动图的研究显示严重程度一致性较差。在6项评估CMR预后价值的研究中，尽管右心室射血分数是最一致的预后预测指标，但用三尖瓣反流容积（RVol）或反流分数（RF）评估TR具有很强的预后价值。8项研究中观察者间/内的变异性非常好。未发现有进行检查间评估的研究。仍缺乏用于比较不同CMR测量方法的独立参考方法。总之，CMR可能在TR患者的评估中发挥重要作用，通过使用二维间接法指标如RVol和RF进行TR定量和预后评估，但缺乏以四维直接法为基础治疗TR的确定性结局研究，而此类研究是必要的。
