Clinical Impact of Size, Shape, and Orientation of the Tricuspid Annulus in Tricuspid Regurgitation as Assessed by Three-Dimensional Echocardiography

Hiroto Utsunomiya, Yuji Itabashi, Sayuki Kobayashi, Florian Rader, Robert J. Siegel, Takahiro Shiota

Research output: Contribution to journalArticle

Abstract

Background: Tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in an apical four-chamber view on two-dimensional (2D) transthoracic echocardiography (TTE). We performed a combined 2D and three-dimensional (3D) echocardiographic study to understand the impact of the size, shape, and orientation of a dilated annulus on the inconsistencies between measured 2D TTE-TAD and the actual annular diameter. Methods: A total of 185 patients with grade ≥3+ TR and 50 controls underwent 2D TTE and 3D transesophageal echocardiography (TEE) assessment of the tricuspid valve. The 3D TEE-TAD, defined as the longest dimension, and tricuspid annulus (TA) eccentricity index, defined as the shortest/longest dimension ratio, were obtained. The angle between the major tricuspid annulus axis and interatrial septum parallel to the vertical axis (α°) was measured as an index of TA orientation. Results: Compared with controls, TR subgroups had a larger α° irrespective of TR etiology and cardiac rhythm (P < .05), with the posteriorly displaced TA most frequently noted in patients with atrial fibrillation. An excellent correlation was found between 3D TEE-TAD and 2D TTE-TAD, but 2D TTE-TAD was significantly smaller than 3D TEE-TAD (35.9 ± 5.4 vs 39.8 ± 5.7 mm; P < .001; bias, 3.9 ± 2.6 mm; limits of agreement, −1.1-8.9 mm). After multivariate adjustment, a larger 3D TEE-TAD and larger absolute value of 90° − α° were independent determinants of the bias between 3D TEE-TAD and 2D TTE-TAD (both P < .001). Conclusions: The inconsistencies between measured 2D TTE-TAD and the actual annular diameter can be explained through morphologic factors such as TA size and orientation.

Original languageEnglish
JournalJournal of the American Society of Echocardiography
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Three-Dimensional Echocardiography
Tricuspid Valve Insufficiency
Echocardiography
Transesophageal Echocardiography
Tricuspid Valve

Keywords

  • 3D echocardiography
  • Transesophageal echocardiography
  • Transthoracic echocardiography
  • Tricuspid annular diameter
  • Valvular heart disease

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical Impact of Size, Shape, and Orientation of the Tricuspid Annulus in Tricuspid Regurgitation as Assessed by Three-Dimensional Echocardiography. / Utsunomiya, Hiroto; Itabashi, Yuji; Kobayashi, Sayuki; Rader, Florian; Siegel, Robert J.; Shiota, Takahiro.

In: Journal of the American Society of Echocardiography, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in an apical four-chamber view on two-dimensional (2D) transthoracic echocardiography (TTE). We performed a combined 2D and three-dimensional (3D) echocardiographic study to understand the impact of the size, shape, and orientation of a dilated annulus on the inconsistencies between measured 2D TTE-TAD and the actual annular diameter. Methods: A total of 185 patients with grade ≥3+ TR and 50 controls underwent 2D TTE and 3D transesophageal echocardiography (TEE) assessment of the tricuspid valve. The 3D TEE-TAD, defined as the longest dimension, and tricuspid annulus (TA) eccentricity index, defined as the shortest/longest dimension ratio, were obtained. The angle between the major tricuspid annulus axis and interatrial septum parallel to the vertical axis (α°) was measured as an index of TA orientation. Results: Compared with controls, TR subgroups had a larger α° irrespective of TR etiology and cardiac rhythm (P < .05), with the posteriorly displaced TA most frequently noted in patients with atrial fibrillation. An excellent correlation was found between 3D TEE-TAD and 2D TTE-TAD, but 2D TTE-TAD was significantly smaller than 3D TEE-TAD (35.9 ± 5.4 vs 39.8 ± 5.7 mm; P < .001; bias, 3.9 ± 2.6 mm; limits of agreement, −1.1-8.9 mm). After multivariate adjustment, a larger 3D TEE-TAD and larger absolute value of 90° − α° were independent determinants of the bias between 3D TEE-TAD and 2D TTE-TAD (both P < .001). Conclusions: The inconsistencies between measured 2D TTE-TAD and the actual annular diameter can be explained through morphologic factors such as TA size and orientation.",
keywords = "3D echocardiography, Transesophageal echocardiography, Transthoracic echocardiography, Tricuspid annular diameter, Valvular heart disease",
author = "Hiroto Utsunomiya and Yuji Itabashi and Sayuki Kobayashi and Florian Rader and Siegel, {Robert J.} and Takahiro Shiota",
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T1 - Clinical Impact of Size, Shape, and Orientation of the Tricuspid Annulus in Tricuspid Regurgitation as Assessed by Three-Dimensional Echocardiography

AU - Utsunomiya, Hiroto

AU - Itabashi, Yuji

AU - Kobayashi, Sayuki

AU - Rader, Florian

AU - Siegel, Robert J.

AU - Shiota, Takahiro

PY - 2019/1/1

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N2 - Background: Tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in an apical four-chamber view on two-dimensional (2D) transthoracic echocardiography (TTE). We performed a combined 2D and three-dimensional (3D) echocardiographic study to understand the impact of the size, shape, and orientation of a dilated annulus on the inconsistencies between measured 2D TTE-TAD and the actual annular diameter. Methods: A total of 185 patients with grade ≥3+ TR and 50 controls underwent 2D TTE and 3D transesophageal echocardiography (TEE) assessment of the tricuspid valve. The 3D TEE-TAD, defined as the longest dimension, and tricuspid annulus (TA) eccentricity index, defined as the shortest/longest dimension ratio, were obtained. The angle between the major tricuspid annulus axis and interatrial septum parallel to the vertical axis (α°) was measured as an index of TA orientation. Results: Compared with controls, TR subgroups had a larger α° irrespective of TR etiology and cardiac rhythm (P < .05), with the posteriorly displaced TA most frequently noted in patients with atrial fibrillation. An excellent correlation was found between 3D TEE-TAD and 2D TTE-TAD, but 2D TTE-TAD was significantly smaller than 3D TEE-TAD (35.9 ± 5.4 vs 39.8 ± 5.7 mm; P < .001; bias, 3.9 ± 2.6 mm; limits of agreement, −1.1-8.9 mm). After multivariate adjustment, a larger 3D TEE-TAD and larger absolute value of 90° − α° were independent determinants of the bias between 3D TEE-TAD and 2D TTE-TAD (both P < .001). Conclusions: The inconsistencies between measured 2D TTE-TAD and the actual annular diameter can be explained through morphologic factors such as TA size and orientation.

AB - Background: Tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in an apical four-chamber view on two-dimensional (2D) transthoracic echocardiography (TTE). We performed a combined 2D and three-dimensional (3D) echocardiographic study to understand the impact of the size, shape, and orientation of a dilated annulus on the inconsistencies between measured 2D TTE-TAD and the actual annular diameter. Methods: A total of 185 patients with grade ≥3+ TR and 50 controls underwent 2D TTE and 3D transesophageal echocardiography (TEE) assessment of the tricuspid valve. The 3D TEE-TAD, defined as the longest dimension, and tricuspid annulus (TA) eccentricity index, defined as the shortest/longest dimension ratio, were obtained. The angle between the major tricuspid annulus axis and interatrial septum parallel to the vertical axis (α°) was measured as an index of TA orientation. Results: Compared with controls, TR subgroups had a larger α° irrespective of TR etiology and cardiac rhythm (P < .05), with the posteriorly displaced TA most frequently noted in patients with atrial fibrillation. An excellent correlation was found between 3D TEE-TAD and 2D TTE-TAD, but 2D TTE-TAD was significantly smaller than 3D TEE-TAD (35.9 ± 5.4 vs 39.8 ± 5.7 mm; P < .001; bias, 3.9 ± 2.6 mm; limits of agreement, −1.1-8.9 mm). After multivariate adjustment, a larger 3D TEE-TAD and larger absolute value of 90° − α° were independent determinants of the bias between 3D TEE-TAD and 2D TTE-TAD (both P < .001). Conclusions: The inconsistencies between measured 2D TTE-TAD and the actual annular diameter can be explained through morphologic factors such as TA size and orientation.

KW - 3D echocardiography

KW - Transesophageal echocardiography

KW - Transthoracic echocardiography

KW - Tricuspid annular diameter

KW - Valvular heart disease

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