Key result
Three-dimensional echocardiography established reference values for tricuspid annulus geometry in healthy adults, including an end-diastolic area of 9.6 ± 2.1 cm2, and demonstrated that 2D echocardiography significantly underestimates actual dimensions.
Why the study?
Although guidelines recommend 2DE for tricuspid annulus sizing, the annulus is a complex 3D structure, prompting the need to identify reference values using dedicated 3DE software.
Does three-dimensional echocardiography provide more accurate tricuspid annulus sizing compared to two-dimensional echocardiography in healthy adults?
Cross-Sectional (n=254)
Does three-dimensional echocardiography provide more accurate tricuspid annulus sizing compared to two-dimensional echocardiography in healthy adults?
Three-dimensional echocardiography provides sex-specific and BSA-indexed reference values for the tricuspid annulus, demonstrating that conventional 2D echocardiography significantly underestimates its true dimensions.
May enhance tricuspid annulus assessment accuracy; extends normative data but leaves clinical impact open.
Background Tricuspid annulus (TA) sizing is essential for planning percutaneous or surgical tricuspid procedures. According to current guidelines, TA linear dimension should be assessed using two-dimensional echocardiography (2DE). However, TA is a complex three-dimensional (3D) structure. Aim Identify the reference values for TA geometry and dynamics and its physiological determinants using a commercially available three-dimensional echocardiography (3DE) software package dedicated to the tricuspid valve (4D AutoTVQ, GE). Methods A total of 254 healthy volunteers (113 men, 47 ± 11 years) were evaluated using 2DE and 3DE. TA 3D area, perimeter, diameters, and sphericity index were assessed at mid-systole, early- and end-diastole. Right atrial (RA) and ventricular (RV) end-diastolic and end-systolic volumes were also measured by 3DE. Results The feasibility of the 3DE analysis of TA was 90%. TA 3D area, perimeter, and diameters were largest at end-diastole and smallest at mid-systole. Reference values of TA at end-diastole were 9.6 ± 2.1 cm 2 for the area, 11.2 ± 1.2 cm for perimeter, and 38 ± 4 mm, 31 ± 4 mm, 33 ± 4 mm, and 34 ± 5 mm for major, minor, 4-chamber and 2-chamber diameters, respectively. TA end-diastolic sphericity index was 81 ± 11%. All TA parameters were correlated with body surface area (BSA) ( r from 0.42 to 0.58, p < 0.001). TA 3D area and 4-chamber diameter were significantly larger in men than in women, independent of BSA ( p < 0.0001). There was no significant relationship between TA metrics with age, except for the TA minor diameter ( r = −0.17, p < 0.05). When measured by 2DE in 4-chamber (29 ± 5 mm) and RV-focused (30 ± 5 mm) views, both TA diameters resulted significantly smaller than the 4-chamber (33 ± 4 mm; p < 0.0001), and the major TA diameters (38 ± 4 mm; p < 0.0001) measured by 3DE. At multivariable linear regression analysis, RA maximal volume was independently associated with both TA 3D area at mid-systole ( R 2 = 0.511, p < 0.0001) and end-diastole ( R 2 = 0.506, p < 0.0001), whereas BSA ( R 2 = 0.526, p < 0.0001) was associated only to mid-systolic TA 3D area. Conclusions Reference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates actual 3DE TA dimensions. RA maximum volume was the only independent echocardiographic parameter associated with TA 3D area in healthy subjects.
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Muraru et al. (2022) conducted a cross-sectional in Healthy adults (n=254). Three-dimensional echocardiography (3DE) vs. Two-dimensional echocardiography (2DE) was evaluated on Tricuspid annulus 3D area at end-diastole. Three-dimensional echocardiography established reference values for tricuspid annulus geometry in healthy adults, including an end-diastolic area of 9.6 ± 2.1 cm2, and demonstrated that 2D echocardiography significantly underestimates actual dimensions.
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