Cardiac Magnetic Resonance vs 3D Echocardiography in Patients with Severe Tricuspid Regurgitation: Comparison pre- and post-Interventional Repair. (RF_TH_212)

Thursday, January 30, 2025

1:40 PM – 1:50 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

RS

Roberto Sarnari, MD

Clinical Research Associate
Northwestern University Feinberg School of Medicine

Primary Author(s)

RS

Roberto Sarnari, MD

Clinical Research Associate
Northwestern University Feinberg School of Medicine

Co-Author(s)

MK

Minyoung Kim, PhD

Post-doctoral fellow
Northwestern University
VR

Volker Rudolph, MD

Professor
Herz- und Diabeteszentrum Nordrhein-Westfalen Universitätsklinik der Ruhr-Universität Bochum, Germany
MG

Muhammed Gerçek, MD

Doctor
Herz- und Diabeteszentrum Nordrhein-Westfalen Universitätsklinik der Ruhr-Universität Bochum, Germany
JT

James Thomas, MD

Professor
Northwestern University Feinberg School of Medicine
James C. Carr, MD

Professor
Northwestern University Feinberg School of Medicine
Michael Markl, PhD

Professor
Northwestern University Feinberg School of Medicine
Jeesoo Lee, PhD

Research Assistant Professor
Northwestern University Feinberg School of Medicine
Northwestern University

Background: Cardiac magnetic resonance (CMR) is the gold standard technique for right ventricular (RV) volumes and function calculation and can provide highly reproducible measurements in patients with tricuspid regurgitation (TR). 3D Echocardiography (3D Echo) is utilized with a similar purpose, and concordance with CMR is currently being tested. The aim of our study was to compare CMR and 3D Echo measurements of RV volumes and function in patients with severe or worse TR undergoing trans-catheter tricuspid valve intervention (TTVI).

Methods: CMR and 3D Echocardiography were performed in patients pre- and post-TTVI (Cardioband Tricuspid System (Edwards Lifesciences, Irvine, CA) or TTVI with the TriClip (Abbott, Chicago, IL) or the PASCAL device (Edwards Lifesciences, Irvine) were utilized fro TTVI). Right ventricular end-diastolic and end-systolic volumes, stroke volumes and ejection fraction (RVEDV, RVESV, RVSV, RVEF, respectively) were measured on a stack of short-axis steady-state free precession cine images by CMR, and on 3D full volume reconstructions, obtained by stitching consecutive ECG-gated subvolumes from multiple standard 2D acquisitions, by 3D Echo. Commercially available softwares were utilized for quantifications: CVI42 Circle Cardiovascular Imaging, V5.14.2, and EchoPac version 206 (Revision 46.0) Vivid E95, General Electric Healthcare, USA IL. CMR and 3D Echo measurements were obtained in 23 patients pre-TTVI and 12 patients post-TTVI. Changes in RV parameters between pre- and post-TTVI were compared in 11 patients. The average interval between CMR and 3D Echo acquisitions was 6 [0-50] days pre-TTVI and 31 [0-88] days post-TTVI. Post-TTVI 3D Echo and CMR were acquired at least 88 to 196 days after the procedure.

Results: At both pre- and post-TTVI, all RV parameters were underestimated by 3D Echo compared to CMR. Boxplots are reported in Fig 1. EDV and SV measurements were the most discrepant parameters between the two modalities. Intraclass correlation coefficient (ICC) analysis revealed no significant agreement between CMR and 3D Echo for EDV and SV and good agreement for ESV pre- and post-TTVI. EF showed variable agreement from poor pre-TTVI to good agreement post-TTVI. 3D Echo showed a similar degree of post-procedural reduction in RV EDV, ESV, SV and increment in EF. However, 4/11 patients had increased EF by 3D Echo, while 8/11 patients had increased EF by CMR. All statistical analysis results are reported in Table 1.

Conclusion: 3D Echo tends to underestimate RV volumes and function in patients with severe TR pre- and post-TTVI. Significant parameters’ change from pre-to post-TTVI are evidenced by both techniques, although with different levels of significance and with some patients’ shift, except for post-TTVI EF increment. Agreement between the two techniques proved to be good only for RVESV measurement in patients with severe TR pre- and post-interventional.