Utility of the Ratio Between the Size of the Right Atrium and the Right Ventricle at End-Systole to Diagnose Atrial Secondary Tricuspid Regurgitation - 03/03/25
, Samantha Fisicaro, RDCS c, Marco Penso, BME c, Michele Tomaselli, MD c, Noela Radu, MD c, Caterina Delcea, MD, PhD c, d, Alexandra S. Buta, MD c, d, Valeria Rella, MD, PhD c, Radu Sascau, MD, PhD b, Luigi P. Badano, MD, PhD a, cAbstract |
Background |
In the multiparametric framework for diagnosing atrial secondary tricuspid regurgitation (A-STR), an end-systolic (ES) right atrial (RA)–to–right ventricular (RV) volume or area ratio ≥1.5 supports the diagnosis of A-STR over the ventricular secondary tricuspid regurgitation phenotype (V-STR). However, this threshold value has never been tested.
Methods |
A single-center study was conducted, prospectively enrolling consecutive patients with secondary tricuspid regurgitation who underwent two- and three-dimensional echocardiography.
Results |
A total of 350 patients were enrolled (mean age, 75 ± 13 years; 65% women). Although patients with A-STR and V-STR presented similar degrees of secondary tricuspid regurgitation and comparable RA size, the ES RA/RV volume ratio was significantly larger in A-STR than in V-STR (1.75 [interquartile range, 1.35-2.45] vs 1.18 [interquartile range, 0.81-1.66], respectively; P < .001). On receiver operating characteristic analysis, the ES RA/RV volume ratio showed a significantly higher predictive power for A-STR (area under the curve [AUC], 0.73; 95% CI, 0.68-0.78) compared with RA maximum volume (AUC, 0.6; 95% CI, 0.54-0.66; P = .01), RA minimum volume (AUC, 0.59; 95% CI, 0.53-0.65; P = .007), and ratio of RA minimum volume to RV end-diastolic volume (AUC, 0.57; 95% CI, 0.51-0.63; P < .001). However, the predictive power of the ES RA/RV volume ratio (AUC, 0.73; 95% CI, 0.68-0.78) and the ES RA/RV area ratio (AUC, 0.76; 95% CI, 0.71-0.81) for the diagnosis of A-STR was similar (P = .58). The threshold value for ES RA/RV volume ratio that best distinguished between A-STR and V-STR was 1.40 (AUC, 0.68; 95% CI, 0.63-0.73), whereas for ES RA/RV area ratio, it was 1.6 (AUC, 0.64; 95% CI, 0.59-0.69). A multivariable model that included either ES RA/RV volume ratio or ES RA/RV area ratio, along with LV ejection fraction, RV ejection fraction, RV ES volume, and pulmonary artery systolic pressure, resulted in an AUC of 0.97 for differentiating between A-STR and V-STR.
Conclusions |
ES RA/RV volume ratio ≥ 1.4 and ES RA/RV area ratio ≥ 1.6 support the diagnosis of A-STR over V-STR.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Echocardiographic assessment of ES RA/RV volume and area ratios in A-STR vs V-STR: study design, main findings, and incremental diagnostic value for A-STR diagnosis. LVEF, LV ejection fraction; RVEF, RV ejection fraction.
Echocardiographic assessment of ES RA/RV volume and area ratios in A-STR vs V-STR: study design, main findings, and incremental diagnostic value for A-STR diagnosis. LVEF, LV ejection fraction; RVEF, RV ejection fraction.
Central IllustrationEchocardiographic assessment of ES RA/RV volume and area ratios in A-STR vs V-STR: study design, main findings, and incremental diagnostic value for A-STR diagnosis. LVEF, LV ejection fraction; RVEF, RV ejection fraction.Le texte complet de cet article est disponible en PDF.
Highlights |
• | A-STR is characterized by disproportionate RA dilation compared with RV size. |
• | The ES RA/RV volume and area ratios help distinguish A-STR from V-STR. |
• | Assessing ES RA/RV volume or area ratio in patients with STR is encouraged. |
Keywords : Atrial secondary tricuspid regurgitation, Ventricular secondary tricuspid regurgitation, Echocardiography, Three-dimensional echocardiography, Right atrial volume, Right ventricular volume, Right atrial area, Right ventricular area
Abbreviations : 2DE, 3DE, AF, A-STR, AUC, ES, HFpEF, ICC, IQR, LV, OR, PASP, PISA, RA, ROC, RV, STR, TR, TV, V-STR
Plan
| This paper was supported by Italian Ministry of Health – Ricerca Finalizzata (grant RF-202112374122). |
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| Alan S. Pearlman, MD, served as guest editor for this report. |
Vol 38 - N° 3
P. 212-223 - mars 2025 Retour au numéro
Article précédent
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