Key result
3D TOE yields superior posterior leaflet visualization scores over TTE in the four-chamber view.
Why the study?
With increasing interventional treatment of the tricuspid valve, there is a need for a standardized scoring system to assess the accuracy of 3D echocardiographic imaging of the tricuspid valve and its anatomical structures.
Does a new 3D echocardiographic scoring system accurately assess the visualisation quality of the tricuspid valve and its anatomical structures using TOE compared to TTE?
Cohort (n=108)
No
Does a new 3D echocardiographic scoring system accurately assess the visualisation quality of the tricuspid valve and its anatomical structures using TOE compared to TTE?
Absolute Event Rate: 2% vs 1.64%
p-value: p=0.001
A novel 3D echocardiographic scoring system demonstrates that TOE generally provides superior visualisation of tricuspid valve structures compared to TTE, with the tricuspid ring being the easiest structure to visualise, supporting its utility for planning ring-based interventions.
TOE four-chamber views may aid posterior leaflet assessment for tricuspid interventions; leaves open whether novel scoring improves procedural outcomes.
With rising focus on interventional treatment of the tricuspid valve (TV), the need for good echocardiographic imaging increases. Aim of this study was to develop a scoring system describing how accurate three dimensional (3D) echocardiographic imaging of TV and its anatomical structures is. METHODS AND RESULTS: In this retrospective exploratory cohort study, we analysed data from consecutive patients undergoing transoesophageal echocardiography (TOE) and transthoracic echocardiography (TTE). 3D sequences were stored using eight different views. In each view, scoring focused on visualisation of five (in TOE 6) anatomical structures with a maximum of three points per structure for excellent imaging quality. We compared the scores of patients with and without relevant tricuspid regurgitation (TR) (cut-off effective regurgitant orifice 0.4 cm² measured in two-dimensional (2D) TTE using velocity time integral and proximal isovolumetric velocity area). 108 consecutive patients were examined, 40.7% presented with relevant TR. With the exception of coaptation, a higher score was achieved for all structures in TOE than in TTE. TV ring (TVR) was easiest to visualise with TOE in four-chamber view (4 CV) (2.42±0.67 points) presenting the highest score independent of anatomical structure and view. Posterior leaflet had best imaging scores in TOE in 4 CV (2.0±0.86) compared with TTE in 4 CV (1.64±0.80), p=0.001. Patients with relevant TR had significantly better 3D imaging scores in 4 CV compared with patients without relevant TR (TTE p<0.013, TOE p<0.002). CONCLUSION: 4 CV delivers the most detailed information in TTE, whereas multiple views deliver good scores in TOE. As TVR is easiest to visualise, most of the patients would be suitable for a ring-based echocardiography-guided intervention. The score enables a standardised comparison of image quality.
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Kücken et al. (2020) conducted a cohort in Valvular heart disease (Tricuspid regurgitation) (n=108). 3D transoesophageal echocardiography (TOE) vs. 3D transthoracic echocardiography (TTE) was evaluated on 3D imaging score of the posterior leaflet in 4-chamber view (p=0.001). Transoesophageal echocardiography in the four-chamber view provided significantly better 3D imaging scores for the posterior leaflet (2.0 vs 1.64, p=0.001) compared to transthoracic echocardiography.
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