Key result
CMR TR severity grading shows ~24% discordance with echo in adults with congenital heart disease.
Why the study?
To assess the prevalence of different degrees of TR severity using CMR and echocardiographic criteria and examine its effect on RV size and function in ACHD patients.
Does the use of cardiac magnetic resonance criteria alter the grading of tricuspid regurgitation severity compared to echocardiographic criteria in adults with congenital heart disease?
Cross-Sectional (n=115)
No
Does the use of cardiac magnetic resonance criteria alter the grading of tricuspid regurgitation severity compared to echocardiographic criteria in adults with congenital heart disease?
Effect estimate: Kappa 0.333 (95% CI 0.315-0.351)
p-value: p=<0.001
In adults with congenital heart disease, grading tricuspid regurgitation severity by CMR criteria results in lower severity classifications compared to echocardiography, with discordance occurring in approximately 25% of patients.
Discordant TR grading between modalities should not yet change practice; leaves open validation against outcomes in congenital heart disease.
Purpose This study aims to assess the prevalence of different degrees of tricuspid regurgitation (TR) severity using cardiac magnetic resonance (CMR) and echocardiographic criteria and to examine its effect on right ventricular size and function in patients with adult congenital heart disease (ACHD). Methods and results CMR and 2D echocardiographic data from patients with Ebstein's anomaly, atrial septal defects, and repaired Tetralogy of Fallot who were followed up at a university hospital from 2011 to 2023 were retrospectively reviewed. Patients were excluded if the interval between CMR and echocardiography exceeded 6 months or if an arrhythmia occurred during scanning. TR severity was graded using qualitative and semi-quantitative parameters. A total of 115 patients were included. The median interval between the echocardiography and CMR was 42 days. Of 115 patients, 28 patients (24.3%) had discordant TR severity between echocardiography and CMR TR volume, and 25 patients (21.7%) had discordant TR severity between echocardiography and CMR TR fraction. The number of patients with moderate or severe TR was lower when the CMR criteria were applied. The highest proportion of varying TR severity was observed in patients with Ebstein's anomaly (72.7%). The right ventricular end-diastolic volume index did not differ statistically between patients with non-severe TR, as determined by CMR and echocardiographic criteria. Conclusions In a specific group of ACHD patients, 25% showed discordant TR severity, with the highest prevalence in those with Ebstein's anomaly. Application of CMR criteria was found to lower the overall TR severity.
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Tantasutthanon et al. (2026) conducted a cross-sectional in Adult congenital heart disease with tricuspid regurgitation (n=115). Cardiac magnetic resonance (CMR) criteria vs. Echocardiographic criteria was evaluated on Discordance in TR severity between echocardiography and CMR TR volume criteria (Kappa 0.333, 95% CI 0.315-0.351, p=<0.001). Cardiac magnetic resonance criteria for tricuspid regurgitation severity showed fair agreement with echocardiographic criteria (kappa 0.333) in adults with congenital heart disease, with 24.3% of patients exhibiting discordant grading.
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