Quantification of tricuspid regurgitation area by 3-dimensional color Doppler echocardiography considering different clinical settings.

Abstract

The precise assessment of tricuspid regurgitation (TR) using 2D imaging techniques may be associated with significant difficulties due to the nonround regurgitation area. Direct analysis of the regurgitation area by 3D color Doppler echocardiography at the vena contracta (3D VCA) has the potential to adequately quantify even complex TR. This study compared 3D VCA for quantification of the TR with the regurgitant area determined by proximal isovolumetric convergence method (PISA-EROA) considering different clinical settings. In 95 patients with TR of different severity, the regurgitant orifice area was determined by 3D color Doppler echocardiography and by PISA-EROA. Using 3D color Doppler echocardiography, the regurgitant orifice area was determined three times in each patient considering 3 datasets. Mean 3D VCA was 0.27±0.14, 0.27±0.13, and 0.29±0.14cm2 , respectively, as determined by three separate measurements in each of the 95 patients. There was a mean relative deviation between the three measurements in each patient of 12.4±14.9%. The regurgitant orifice area using the PISA method was 0.28±0.14cm2 . There was a mean difference of 0.07cm2 (95% CI -0.124 to 0.138cm2 ) between 3D VCA and PISA-EROA. The correlation between 3D VCA and PISA-EROA was r=.88 (P<.001). Considering a grading of TR severity in grade I (regurgitant area<0.2cm2 ), grade II (area 0.2-0.4cm2 ), and grade III (area>0.4cm2 ), there was a good agreement between severity grade determined by 3D VCA and severity grade determined by PISA-EROA (kappa 0.71). The analysis of the VCA of a TR using 3D color Doppler echocardiography is an alternative method to determine the regurgitant severity with good agreement to the PISA method.