Three-Dimensional Color Doppler Echocardiography Versus Two-Dimensional Derived Method in the Quantification of Tricuspid Regurgitation Orifice Area

Patients: 92 patients with > mild TR (without multiple TR jets) prospectively underwent 2D and 3D transthoracic echocardiography. Patients with atrial fibrillation (AF) were excluded if the ventricular rate was uncontrolled or if there was significant variation in cardiac cycle length. Measurements: 2D quantification included TR jet area/right atrial (RA) area ratio, vena contracta width (VC), and effective regurgitant orifice area (EROA) using the flow convergence method. Fullvolume breathhold 3D color datasets of TR were obtained using a real-time 3D echocardiography system (iE33; Philips Medical Systems, Bothell,WA) with a 1 to 5-MHz 3040-element X5-1 transthoracic transducer. AROA was directly quantified from the 3D full-volume datasets by 3D guided 2D direct planimetry (multiplanar measurement) of the TR color jet AROA using custom software package (QLAB7, Philips Medical Systems, Bothell,WA) [Figure 1]. Five measurements were averaged in patients with AF. Blinded comparisons of EROA and AROA were made. Subgroup analysis included presence of a pacemaker (PPM), eccentricity of TR jet direction, ellipticity of AROA, underlying mechanism of TR and baseline rhythm. Methods Subgroup Analysis: The correlation of AROA with EROA was better for patients without pacemaker (n=63) than with pacemaker (n=29) [Figure 4], better for central (n=72) than eccentric TR (n=20) [Figure5], better for circular AROA (n=39) than elliptical AROA (n=53) [Figure 6], better for organic (n=18) than functional TR (n=74) [Figure 7] and better for regular rhythm (n=72) than AF (n=20) [Figure 8]. Results