Does Pre-TAVR CT Imaging of the Tricuspid Annulus Correlate with Echocardiography?
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5/1/2023
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Abstract
Research Question: In a cohort of patients with varied degrees of tricuspid regurgitation as determined by transthoracic echocardiogram, how does the mid-systolic gated cardiac CT-derived tricuspid annular dimension compare with the similar transannular dimension as calculated by echocardiogram? Which CT-derived tricuspid annular dimensions correlate best with moderate or severe tricuspid regurgitation?
Background, Significance, and Rationale: Transthoracic echocardiography (TTE) is currently the standard imaging choice for assessment of tricuspid annular dilation (TAD) and related tricuspid regurgitation (TR). Its utility is limited frequently by suboptimal image quality due to insufficient acoustic windows and its 2-dimensional approach to visualization of the 3-dimensional and dynamic ellipsoid tricuspid valve apparatus. Multidetector row computed tomography (MDCT) derived annular dimension and right heart assessment is likely to be equally or better suited for analysis of the integrity of the valve and any functional regurgitation present as it is a non-invasive 3-dimensional imaging modality that allows more robust visualization of the apparatus and the right heart chambers. Given that cardiac MDCT imaging is routinely performed in the pre-operative evaluation of patients awaiting transcatheter aortic valve replacement (TAVR), validating the MDCT-derived dimensions could aid physicians in identifying comorbid TAD or functional TR prior to aortic valve replacement and determining if concurrent valve repair is necessary.
Materials and Methods: The patients included in the cohort were identified by cardiac imaging analysis of patients who underwent TAVR within the last five years at Baylor All Saints Hospital in Fort Worth, Texas with MDCT and TTE available in electronic chart review. Twenty-four patients were identified and of which five were diagnosed with tricuspid regurgitation using TTE. Data acquisition and analysis via linear regression was performed to determine correlation between the echocardiographic septo-lateral dimension and the various MDCT values obtained.
Results: Linear regression analysis revealed that the 4-Chamber Diastolic Dimension (p=0.0036, R² = 0.3254) and the Average Diastolic Diameter (p=0.0062, R² = 0.3355) obtained via MDCT showed the most significant (p<0.05) correlation with the diagnostic echocardiographic septo-lateral dimension.
Conclusions: The findings of this study suggest that the MDCT obtained 4-Chamber Diastolic dimension and Average Diastolic Diameter value may identify tricuspid regurgitation via annular dilation to a degree comparable to that of TTE. Further studies should be conducted to ascertain if these results are reproducible with a much larger sample size and multiple observers.
Background, Significance, and Rationale: Transthoracic echocardiography (TTE) is currently the standard imaging choice for assessment of tricuspid annular dilation (TAD) and related tricuspid regurgitation (TR). Its utility is limited frequently by suboptimal image quality due to insufficient acoustic windows and its 2-dimensional approach to visualization of the 3-dimensional and dynamic ellipsoid tricuspid valve apparatus. Multidetector row computed tomography (MDCT) derived annular dimension and right heart assessment is likely to be equally or better suited for analysis of the integrity of the valve and any functional regurgitation present as it is a non-invasive 3-dimensional imaging modality that allows more robust visualization of the apparatus and the right heart chambers. Given that cardiac MDCT imaging is routinely performed in the pre-operative evaluation of patients awaiting transcatheter aortic valve replacement (TAVR), validating the MDCT-derived dimensions could aid physicians in identifying comorbid TAD or functional TR prior to aortic valve replacement and determining if concurrent valve repair is necessary.
Materials and Methods: The patients included in the cohort were identified by cardiac imaging analysis of patients who underwent TAVR within the last five years at Baylor All Saints Hospital in Fort Worth, Texas with MDCT and TTE available in electronic chart review. Twenty-four patients were identified and of which five were diagnosed with tricuspid regurgitation using TTE. Data acquisition and analysis via linear regression was performed to determine correlation between the echocardiographic septo-lateral dimension and the various MDCT values obtained.
Results: Linear regression analysis revealed that the 4-Chamber Diastolic Dimension (p=0.0036, R² = 0.3254) and the Average Diastolic Diameter (p=0.0062, R² = 0.3355) obtained via MDCT showed the most significant (p<0.05) correlation with the diagnostic echocardiographic septo-lateral dimension.
Conclusions: The findings of this study suggest that the MDCT obtained 4-Chamber Diastolic dimension and Average Diastolic Diameter value may identify tricuspid regurgitation via annular dilation to a degree comparable to that of TTE. Further studies should be conducted to ascertain if these results are reproducible with a much larger sample size and multiple observers.
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Burnett School of Medicine