Key result
A preoperative TV-Echo score ≥2 predicted significant residual tricuspid regurgitation after annuloplasty with a sensitivity of 85.7% and a specificity of 71.0%.
Why the study?
Do preoperative 3D echocardiographic parameters of tricuspid valve morphology predict residual tricuspid regurgitation after tricuspid annuloplasty in patients with functional tricuspid regurgitation?
Observational (n=97)
Do preoperative 3D echocardiographic parameters of tricuspid valve morphology predict residual tricuspid regurgitation after tricuspid annuloplasty in patients with functional tricuspid regurgitation?
p-value: p=<0.001
Preoperative 3D echocardiographic assessment of tricuspid valve morphology, including leaflet length and tenting volume, can effectively predict the risk of residual tricuspid regurgitation after annuloplasty.
May aid risk stratification for residual TR after annuloplasty; leaves open whether 3D echo parameters should guide surgical decisions.
AIMS: Tricuspid valve (TV) annuloplasty is an effective treatment for tricuspid regurgitation (TR). However, the impact of TV morphology on outcome of TV annuloplasty remains unknown. We sought to investigate the relationship between preoperative TV morphology and residual TR after annuloplasty. METHODS AND RESULTS: Two-dimensional transthoracic and three-dimensional (3D) transesophageal echocardiography were performed in 97 patients with functional TR before and after surgery. 3D quantitative assessment including annular dimension, tenting height and volume, and lengths and tethering angles of the 3 leaflets was performed. The TV morphological score was derived from the preoperative 3D echocardiography to score a leaflet mobility, leaflet thickening, subvalvular thickening, and calcification. TR severity was determined by the averaged vena contracta measured from the apical and parasternal inflow views. Multivariable analysis revealed that a shorter total leaflet length (P = 0.007), larger tenting volume (P < 0.001), and higher TV morphological score (P < 0.001) were independently associated with residual TR. A TV-Echo score was determined as a sum of points based on receiver operator characteristics analysis: total leaflet length >61.0 mm, 61.0 to 53.5 mm, and <53.5 mm; tenting volume <2.3 mL, 2.3 to 3.5 mL, and >3.5 mL; and TV morphological score <7, 7 to 18, and >18; each variable was associated with 0 and 1 point and 2 points, respectively. The TV-Echo score ≥2 was associated with significant residual TR with a sensitivity of 85.7% and a specificity of 71.0%. CONCLUSION: In addition to tethering and short length of the leaflets, TV morphological abnormality predicted residual TR after TV annuloplasty.
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Utsunomiya et al. (2017) conducted an observational in Functional tricuspid regurgitation (n=97). Preoperative 3D echocardiographic tricuspid valve morphology (TV-Echo score) was evaluated on Residual tricuspid regurgitation (p=<0.001). A preoperative TV-Echo score ≥2 predicted significant residual tricuspid regurgitation after annuloplasty with a sensitivity of 85.7% and a specificity of 71.0%.