Abstract 10145: Comprehensive Evaluation of Tricuspid Regurgitation Location and Severity Using Vena Contracta Analysis: A Color Doppler 3-dimensional Transesophageal Echocardiography Study

Introduction:The clinical significance of three-dimensional (3D) vena contracta area (VCA) in tricuspid regurgitation (TR) is not fully elucidated. We sought to investigate the diagnostic accuracy of 3D VCA using 3D echocardiography-derived regurgitation volume (RVol) as a reference standard.Methods:Two-dimensional (2D) transthoracic and color Doppler 3D transesophageal echocardiographic data were retrospectively reviewed together with measurement of 3D VCA representing the narrowest short-axis plane of the flow convergence zone in 116 patients with at least moderate TR.Results:Severe functional TR showed the highest prevalence of central jet location (91.4%) among the TR subgroups, whereas severe primary TR had thoroughly spread jet location, resulting in a higher number of VC and greater spatial extent of TR jet location involved as compared to moderate TR (all P<0.05; Figure). 3D VCA at an optimal cutoff value of 0.61 cm2yielded a sensitivity of 78% and a specificity of 97% to differentiate moderate from severe TR. The difference between 3D VCA and 2D PISA-EROA was correlated with the number, shape, and spatial extent of VC (all P<0.05), resulting in a 15% misclassification when 2D PISA-EROA was used. In multiple linear regression model, there was a good correlation with RVol (P<0.001), with 3D VCA, dilated right ventricle, and hepatic vein systolic reversal as predictors of RVol, with 3D VCA having the most impact on the model. The ?2for the model that incorporated 3 variables (baseline model, 2D integrative parameters, and the best cutoff value of 3D VCA >0.61 cm2) to predict severe TR was significantly higher than the model that incorporated only baseline model, estimated right atrial pressure, and 2D integrative parameters (P=0.001).Conclusions:3D VCA has an independent and incremental diagnostic value for predicting severe TR. Comprehensive evaluation of TR location and severity using 3D VC analysis will help in treatment selection for TR in the future.