Association With Outcomes of Correcting the Proximal Isovelocity Surface Area Method to Quantitate Secondary Tricuspid Regurgitation - 03/03/25
, Alexandra Clement, MD c, Noela Radu, MD a, Francesca Heilbron, MD a, Mara Gavazzoni, MD a, Diana R. Hădăreanu, MD, PhD d, Giorgio Oliverio, MD a, Samantha Fisicaro, RDCS a, Paolo Springhetti, MD e, Cinzia Pece, MD a, b, Caterina Delcea, MD, PhD f, Denisa Muraru, MD, PhD a, bAbstract |
Background |
Although the correction of the proximal isovelocity surface area (PISA) method has been shown to improve the accuracy of assessing the severity of secondary tricuspid regurgitation (STR), its clinical impact remains to be investigated. The aim of this study was to compare the association of the quantitative parameters of STR severity obtained from the corrected and conventional PISA methods with outcomes.
Methods |
Both conventional and corrected effective regurgitant orifice area (EROA) (EROA vs corrected EROA [EROAc]), regurgitant volume (RegVol) (RegVol vs corrected RegVol [RegVolc]), and regurgitant fraction (RegFr) (RegFr vs corrected RegFr [RegFrc]) were measured in 519 consecutive patients (mean age, 75 ± 12 years; 44% men; 74% with ventricular STR) with moderate and severe STR. The end point was a composite of heart failure hospitalization and death.
Results |
EROAc, RegVolc, and RegFrc were significantly larger than EROA, RegVol, and RegFr (P < .001 for all). After a mean follow-up period of 19 ± 15 months, 210 patients reached the end point. Using time-dependent receiver operating characteristic curves, the parameters obtained from the corrected PISA method were more closely associated with outcomes at 2 years than those obtained with the conventional PISA method: EROAc vs EROA (P < .001), RegVolc vs RegVol (P = .001), and RegFrc vs RegFr (P < .001) for ventricular STR. Conversely, no significant differences were detected for atrial STR. After multivariable adjustment, both uncorrected and corrected EROA, RegVol, and RegFr were independently associated with the end point. Using the new five-grade severity scheme, patients reclassified using the corrected PISA method had a significantly higher rate of events compared with those not reclassified among those with ventricular STR (P = .0086). Conversely, this relationship was not statistically significant in patients with atrial STR (P = .061).
Conclusions |
Correcting the PISA method provides larger quantitative parameters of STR severity that are more closely associated with outcomes in patients with ventricular STR.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Association with outcomes of correcting the PISA method in STR. SV, Stroke volume; Va, aliasing velocity; Vp, peak tricuspid regurgitation velocity; VTI, velocity-time integral.
Association with outcomes of correcting the PISA method in STR. SV, Stroke volume; Va, aliasing velocity; Vp, peak tricuspid regurgitation velocity; VTI, velocity-time integral.
Central IllustrationAssociation with outcomes of correcting the PISA method in STR. SV, Stroke volume; Va, aliasing velocity; Vp, peak tricuspid regurgitation velocity; VTI, velocity-time integral.Le texte complet de cet article est disponible en PDF.
Highlights |
• | The conventional PISA method underestimates the severity of STR. |
• | In V-STR, applying the corrected PISA method refines risk stratification. |
• | Reclassifying TR severity identifies patients at higher risk. |
Keywords : Secondary tricuspid regurgitation, Tricuspid regurgitation severity, Echocardiography, PISA method, Effective regurgitant orifice area, Regurgitant volume, Regurgitant fraction, Outcome
Abbreviations : A-STR, AUC, EROA, EROAc, HF, HR, LOA, LV, LVEF, MR, NYHA, PISA, RA, RegFr, RegFrc, RegVol, RegVolc, RV, RVEF, STR, TR, TV, Va, VC, VCmax, VCmin, Vp, V-STR
Plan
| This research was supported by the Italian Ministry of Health – Ricerca Finalizzata (grant RF-202112374122). |
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| Drs Tomaselli and Penso contributed equally to this work. |
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| Jordan B. Strom, MD, MSc, served as guest editor for this report. |
Vol 38 - N° 3
P. 195-207 - mars 2025 Retour au numéro
Article précédent
- Impact of Length Indexing of Deformation in Echocardiographic Evaluation of Right Ventricular Function
- Weiting Huang, James Hodovan, Avneesh Sharma, Matteo Morello, Onur Varli, Bethany Gholson, Jonathan R. Lindner
- The Forgotten Truth About Proximal Isovelocity Surface Area Correction in Tricuspid Regurgitation
- Ratnasari Padang, Jeremy J. Thaden
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