Author + information
Background: Concomitant tricuspid regurgitation (TR) has the prognostic significance in patients with left sided heart valve disease. We sought to determine the mechanism of TR in left sided heart valve disease by three-dimensional transesophageal echocardiography (3D-TEE).
Methods: Consecutive 153patients (age 68 ± 14 years, 93men) who had equal to or more than moderate left sided heart valve disease in consideration with cardiac surgery were enrolled. All patients underwent 3D-TEE and right heart catheterization. We measured mediolateral (ML) and anteroposterior (AP) distance of tricuspid annulus from 3DTEE data sets. We compared patients backgrounds, echocardiographic parameters and right heart pressure between two groups; moderate or more TR group (Group A, n=21), mild or less TR group (Group B, n=132).
Results: AP was similar in two groups (p=0.12). In Group A, ML (35.9 vs. 29mm, p<0.0001) was longer and AP/ML ratio (1.10 vs. 1.29, p<0.0001) was smaller than in Group B. Mean pulmonary artery pressure (25.7 vs. 20.8mmHg, p=0.007) and mean pulmonary artery wedge pressure (18.6 vs. 13.8mmHg, p=0.002) were higher in Group A. Atrial fibrillation (AF) was more frequent in Group A (85.7 vs. 20.4%, p<0.0001). Right ventricular end systolic area was similar (p=0.59) and right atrial area was larger (24.5 vs. 15.8cm2, p<0.0001) in Group A. The receiver operator characteristics curves demonstrated that the AP/ML ratio has good capacity in predicting moderate or more TR with respective areas under the curve of 0.85 and identified an AP/ML ratio<1.15 have 86% sensitivity and 83% specificity for moderate or more TR. Multivariate logistic regression analysis revealed AF (p<0.0001 ; OR, 244.9; 95% CI, 44.4-2451.3), age (p=0.001 ; OR, 1.1; 95% CI, 0.96-1.1) and mean pulmonary artery pressure (p= 0.01; OR, 1.1 ; 95% CI, 1.0-1.2) to be independent predictors for AP/ML ratio<1.15.
Conclusions: In patients with moderate or more TR, tricuspid annulus became more circular with decreased AP/ML ratio. Our data suggested that AF had more effect on annular dilatation and worsening of regurgitation than pulmonary hypertension following the elevation of left atrial pressure due to left-sided valvular heart disease.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Tricuspid Regurgitation: Signals in Plain Sight
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1303M-05
- 2017 American College of Cardiology Foundation