Multimodal Assessment of Tricuspid Valve Regurgitation: A Comparative Study of 2D and 3D Echocardiography with Cardiac MRI

Philipp Doldi (München)1, L. Weckbach (München)1, N. Fink (München)2, L. Stolz (München)1, T. Stocker (München)1, J. Dinkel (München)2, S. Massberg (München)1, J. Cavalcante (Minneapolis)3, J. Hausleiter (München)1

1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 2LMU Klinikum der Universität München Institut für Klinische Radiologie München, Deutschland; 3Allina Health Minneapolis Heart Institute Abbott Northwestern Hospital Minneapolis, USA



Tricuspid valve regurgitation (TR) and right ventricular (RV) dysfunction have long been overshadowed in clinical practice due to limited diagnostic tools and high-risk surgical treatment options. However, recent developments have highlighted the prognostic significance of TR, emphasizing the need for precise TR severity assessment and an accurate evaluation of RV function. This study seeks to address these challenges by comparing three imaging modalities (2D echocardiography, 3D echocardiography, and cardiac MRI), proposing a 5-class grading scheme for MRI, and emphasizing the crucial role of precise TR grading in guiding tricuspid interventions. Furthermore, we introduce a novel 5-class grading scheme for MRI, acknowledging the pivotal role of precise TR grading in the context of tricuspid interventions.


Methods and Results:

Seventy-three patients with TR were included in the study. Patients underwent 2DE, 3DE, and cardiac MRI at the University Hospital of Munich. Notably, 3DE demonstrated a superior accuracy rate, aligning with MRI findings in 85% of cases, albeit underestimating RV volumes compared to MRI. TR severity grading revealed significant discrepancies between 2DE and MRI, while 3DE demonstrated a notably better agreement with MRI. Additionally, 3DE showed comparable results in measuring RV function (3DE vs. MRI: p=0.25). Importantly, we extended the echocardiographic 5-class grading scheme to MRI, providing a comprehensive framework for TR assessment across modalities.



This research underscores the clinical utility of 3DE as a reliable method for assessing RV function and TR severity, potentially serving as a promising alternative to MRI. Accurate TR grading plays a pivotal role in guiding intervention decisions. Multimodality imaging, including MRI, is recommended for orthotopic transcatheter tricuspid valve repair and replacement therapies to guarantee the most accurate assessment of TR severity and RV remodeling. Accurate TR grading, across various imaging modalities, is essential to prevent both under- and overtreatment and to optimize patient care.

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