Key result
4D flow CMR shows frequent discordance with TTE in grading TR.
Why the study?
CMR is valuable for assessing valvular disease, but its utilization in evaluating tricuspid regurgitation has been limited.
Does 4D flow CMR agree with TTE in grading tricuspid regurgitation severity in patients with ≥ moderate TR?
Observational (n=52)
No
Does 4D flow CMR agree with TTE in grading tricuspid regurgitation severity in patients with ≥ moderate TR?
Effect estimate: kappa = 0.28 (95% CI 0.13-0.45)
p-value: p=<0.001
Grading of tricuspid regurgitation severity is frequently discordant between TTE and 4D flow CMR, with CMR often grading severity lower than TTE.
Discordant TR grading between TTE and 4D-CMR warrants caution in severity assessment; leaves open CMR's role in management pending outcome data.
BACKGROUND: Cardiac magnetic resonance (CMR) is a valuable tool in the assessment of valvular disease. However, its utilization in tricuspid regurgitation (TR) evaluation has been limited. OBJECTIVES: The authors sought to compare TR grading with 4D-CMR and transthoracic echocardiography (TTE). METHODS: We prospectively recruited patients with ≥ moderate TR on TTE to undergo multiparametric CMR with integrated cardiac function and 4D flow assessments using a 1.5-T scanner (Siemens Somatom Aera). Patients with other severe valvulopathy, end-stage renal disease, or pacemakers were excluded. TR was graded severe on CMR when TR volume ≥45 mL and/or TR fraction ≥50%. The weighted kappa test was used to assess the agreement in overall TR grading on TTE and CMR. RESULTS: Fifty-two patients were enrolled (mean age 78.5 ± 7.6 years, 53.8% men). The median interval between CMR and TTE was 2 days (Q1-Q3: 1-37 days). The agreement between TTE and CMR-derived TR volume was fair (kappa = 0.28, 95% CI: 0.13-0.45), with only 10 of 31 patients (32%) with ≥ severe TR on TTE meeting severe TR volume criterion on CMR (TR volume ≥45 mL). There was no agreement between TTE and CMR-derived TR fraction (kappa = 0.04, 95% CI: 0.13-0.46), with only 3 of 31 patients (13%) with ≥ severe TR on TTE meeting severe TR criterion on CMR (TR fraction ≥50%). CONCLUSIONS: Grading of TR was frequently discordant between TTE and 4D magnetic resonance imaging. Further studies are needed to elucidate the clinical impact of concordant/discordant TR grading on multimodality imaging.
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Sularz et al. (2025) conducted an observational in Tricuspid Regurgitation (n=52). 4D Flow Cardiac Magnetic Resonance vs. Transthoracic Echocardiography was evaluated on Agreement in severe vs nonsevere tricuspid regurgitation classification between TTE and CMR-derived TR volume (kappa = 0.28, 95% CI 0.13-0.45, p=<0.001). Grading of tricuspid regurgitation was frequently discordant between transthoracic echocardiography and 4D flow cardiac magnetic resonance, with only fair agreement for TR volume (kappa = 0.28).
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