3D Echocardiographic and CMR Imaging for the Assessment of Right Ventricular Function and Tricuspid Regurgitation Severity.

Philipp M Doldi,Ludwig T Weckbach, Nicola Fink,Lukas Stolz, Cecilia Ennin, Julien Dinkel,Philipp Lurz,Holger Thiele, Rebecca T Hahn,João L Cavalcante,Christian Besler,Jörg Hausleiter

Circulation Cardiovascular imaging（2025）

Medizinische Klinik und Poliklinik für Radiologie | Department of Cardiology | Department of Medicine | Allina Health Minneapolis Heart Institute

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Abstract

BACKGROUND:Tricuspid regurgitation (TR) is associated with increased mortality and is often underdiagnosed due to limitations in imaging modalities. While routine 2-dimensional echocardiography (2DE) demonstrates frequent disagreement with cardiac magnetic resonance imaging (CMR) in classifying TR severity, the incremental value of 3-dimensional echocardiography (3DE) remains unknown also due to the lack of a generalizable grading scheme across imaging modalities. Therefore, this study provides an intermodality comparison of all 3 imaging modalities (2DE, 3DE, and CMR) in evaluating TR severity and proposes an adapted 5-class grading scheme for TR severity using CMR. METHODS:A total of 144 patients with symptomatic TR were analyzed across 2 cohorts: a derivation cohort (n=91) from the University Hospital of Munich and a validation cohort (n=53) from the Heart Center Leipzig. All patients underwent multimodality imaging, including transthoracic 2DE, transesophageal 3DE, and CMR. The adapted 5-class CMR-based grading scheme was proposed and externally validated. RESULTS:In the derivation cohort (median age 81 years, 66% female), TR severity grading by 3DE highly correlated with CMR (87% concordance within a 1-grade difference), significantly outperforming 2DE (68% concordance). While 3DE underestimated right ventricular dimensions compared with CMR (P<0.001), it provided a comparable measure of TR severity and right ventricular function. 2DE achieved the lowest accuracy rates compared with CMR (34.5%; P=0.005) with frequent overestimation of TR severity. An overestimation of TR severity by 3DE compared with CMR was significantly less frequent than with 2DE (21% versus 56%; P<0.001). Cohen κ analysis confirmed a substantial and superior agreement between 3DE and CMR compared with 2DE (κ=0.63 versus 0.41; P=0.01). The results were externally validated, showing comparable results within the derivation and validation cohorts. CONCLUSIONS:3DE provides an accurate assessment of TR severity comparable to CMR. The proposed 5-class grading scheme for TR severity using CMR demonstrates high accuracy and external validity.

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【要点】：本研究通过比较2DE、3DE和CMR三种成像方式评估三尖瓣反流（TR）严重程度，提出了一种基于CMR的5级TR严重程度分级方案，3DE在评估TR严重程度方面与CMR具有高度一致性。

【方法】：对144名症状性TR患者进行多模式成像分析，包括经胸2DE、经食管3DE和CMR，提出并验证了一种基于CMR的5级TR严重程度分级方案。

【实验】：在慕尼黑大学医院（n=91）的推导队列和莱比锡心脏中心（n=53）的验证队列中进行了实验，3DE与CMR在TR严重程度分级上具有87%的一致性（在一个等级差异内），显著优于2DE的68%一致性。所提出的5级分级方案在推导和验证队列中均显示出高准确性和外部有效性。