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<p>Tricuspid valve annulus (TA) dilatation is key in the pathogenesis of secondary tricuspid regurgitation (TR), but occurs asymmetrically. It is yet to be determined whether TA diameter measured from specific 2D planes and at specific time-points would reliably reflect this complex geometry related to secondary TR. We investigated the correlation of diastolic and systolic TA diameters measured from two echocardiographic views with TR severity and with right ventricular (RV), right atrial (RA), and tricuspid valve (TV) remodeling. In consecutive older subjects from the prospective Tricuspid Regurgitation in the ElderlY (TREY) Registry (ClinicalTrials.gov ID: NCT05784883), 2D TA diameter was measured on transthoracic echocardiography from the parasternal two-chamber view in end-diastole (P2Cd) and the apical four-chamber view in end-diastole and end-systole (A4Cd and A4Cs). In a subgroup of patients (<i>n</i> = 97), 3D images were used to measure TA area, perimeter, and different diameters. Out of 435 patients (age, 66 ± 6 years; 46% female), 42% had mild and 16% had moderate/severe TR. The correlation between P2Cd and A4Cd was modest (<i>r</i> = 0.391) and P2Cd was 0.17[95% CI 0.10–0.25] cm smaller (<i>p</i> &lt; 0.001). The correlation between A4Cd and A4Cs diameters was strong (<i>r</i> = 0.867), with A4Cs being 0.70[95% CI 0.66–0.72] cm smaller than A4Cd (<i>p</i> &lt; 0.001). P2Cd correlated poorly with RV, RA, and TV remodeling indices, while A4C diameters correlated substantially with those indices. A4Cd showed a stronger correlation with RA area (Β<sup>standardized</sup> = 0.34, <i>p</i> &lt; 0.001) and RV basal diastolic diameter (Β<sup>standardized</sup> = 0.61, <i>p</i> = 0.006), while A4Cs showed a stronger correlation with RV fractional area change (Β<sup>standardized</sup> = − 0.15, <i>p</i> = 0.001) and TV tenting area (Β<sup>standardized</sup> = 0.16, <i>p</i> &lt; 0.001). TA diameter cut off values corresponding to moderate/severe TR were: 3.3 cm for P2Cd (AUC[95% CI] 0.67[0.61–0.74]; sensitivity, 76%; specificity, 54%); 3.7 cm for A4Cd (AUC[95% CI] 0.79[0.73–0.86]; sensitivity, 75%; specificity, 73%); and 3.0 cm for A4Cs diameter (AUC[95% CI]: 0.77[0.70–0.84]; sensitivity, 70%; specificity, 74%). In those with dilatation of neither, either, or both A4Cd and A4Cs, the frequency of moderate/severe TR was 5.7%, 15.9%, and 42.6%; respectively. None of the 3D parameters outperformed A4Cd and A4Cs in predicting moderate/severe TR. TA diameter measured from the P2C view is generally less correlated with RV, RA, and TV remodeling and with TR severity than A4C diameters. A4Cd and A4Cs provide complementary evaluation of the TA that reflects different aspects of right heart chamber and TV remodeling and correlate strongly with TR severity.</p><p><i>Trial registration</i> ClinicalTrials.gov ID: NCT05784883.</p> Graphical abstract <p></p>

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Tricuspid annulus dilatation in secondary tricuspid regurgitation: impact of the echocardiographic view and the cardiac-cycle phase of measurement

  • 期刊论文

  • 发表日期：

    2026年3月15日

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  • Mohammad Abdelghani,
  • Mahmoud Abdelshafy,
  • Mohamed Elbadawi,
  • Sheref Mohey,
  • Ahmed M. Elnahas,
  • Mostafa Elrefay Soltan,
  • Mohamed Hamdy Elsisi,
  • Hazem Awad Eltawela,
  • Mohamed Muharram,
  • Wael Attia

摘要

Tricuspid valve annulus (TA) dilatation is key in the pathogenesis of secondary tricuspid regurgitation (TR), but occurs asymmetrically. It is yet to be determined whether TA diameter measured from specific 2D planes and at specific time-points would reliably reflect this complex geometry related to secondary TR. We investigated the correlation of diastolic and systolic TA diameters measured from two echocardiographic views with TR severity and with right ventricular (RV), right atrial (RA), and tricuspid valve (TV) remodeling. In consecutive older subjects from the prospective Tricuspid Regurgitation in the ElderlY (TREY) Registry (ClinicalTrials.gov ID: NCT05784883), 2D TA diameter was measured on transthoracic echocardiography from the parasternal two-chamber view in end-diastole (P2Cd) and the apical four-chamber view in end-diastole and end-systole (A4Cd and A4Cs). In a subgroup of patients (n = 97), 3D images were used to measure TA area, perimeter, and different diameters. Out of 435 patients (age, 66 ± 6 years; 46% female), 42% had mild and 16% had moderate/severe TR. The correlation between P2Cd and A4Cd was modest (r = 0.391) and P2Cd was 0.17[95% CI 0.10–0.25] cm smaller (p < 0.001). The correlation between A4Cd and A4Cs diameters was strong (r = 0.867), with A4Cs being 0.70[95% CI 0.66–0.72] cm smaller than A4Cd (p < 0.001). P2Cd correlated poorly with RV, RA, and TV remodeling indices, while A4C diameters correlated substantially with those indices. A4Cd showed a stronger correlation with RA area (Βstandardized = 0.34, p < 0.001) and RV basal diastolic diameter (Βstandardized = 0.61, p = 0.006), while A4Cs showed a stronger correlation with RV fractional area change (Βstandardized = − 0.15, p = 0.001) and TV tenting area (Βstandardized = 0.16, p < 0.001). TA diameter cut off values corresponding to moderate/severe TR were: 3.3 cm for P2Cd (AUC[95% CI] 0.67[0.61–0.74]; sensitivity, 76%; specificity, 54%); 3.7 cm for A4Cd (AUC[95% CI] 0.79[0.73–0.86]; sensitivity, 75%; specificity, 73%); and 3.0 cm for A4Cs diameter (AUC[95% CI]: 0.77[0.70–0.84]; sensitivity, 70%; specificity, 74%). In those with dilatation of neither, either, or both A4Cd and A4Cs, the frequency of moderate/severe TR was 5.7%, 15.9%, and 42.6%; respectively. None of the 3D parameters outperformed A4Cd and A4Cs in predicting moderate/severe TR. TA diameter measured from the P2C view is generally less correlated with RV, RA, and TV remodeling and with TR severity than A4C diameters. A4Cd and A4Cs provide complementary evaluation of the TA that reflects different aspects of right heart chamber and TV remodeling and correlate strongly with TR severity.

Trial registration ClinicalTrials.gov ID: NCT05784883.

Graphical abstract