CT Based Planimetry Of Tricuspid Regurgitation Anatomic Regurgitant Orifice Area Correlation With Echo Metrics Of Severity And Utilizing CT Metrics To Augment Echo-based Quantification Techniques

Document Type

Conference Proceeding

Publication Date

7-1-2025

Publication Title

J Cardiovasc Comput Tomogr

Abstract

Introduction: Tricuspid regurgitation (TR) is a cause of significant morbidity and mortality. Due to the complex anatomy of the tricuspid valve, the echo assessment of the regurgitation severity can be challenging to grade reproducibility. Effective regurgitant orifice area (EROA) has demonstrated a direct link to clinical outcomes. ECG gated CT angiography (CCTA) offers high temporal resolution of tricuspid valve anatomy, allowing for accurate measurement of the true anatomic AROA. This measurement may be challenging, even on transesophageal echocardiogram due to limitations in available acquisition windows. Data comparing these measurements is scarce and our aim was to better assess their correlation and subsequent clinical utility Methods: Retrospective analysis was performed on 42 patients who underwent TTVR using the EVOQUE tricuspid valve between August 2024 and February 2025. All patients had pre-procedural imaging with CT and TEE. AROA on structural CT (TV coaptation gap by planimetry) was compared with CT derived volumetric systolic IVC contrast reflux volume, as well as TEE derived TR vena contracta, calculated EROA regurgitant volume and preprocedural integrative TR severity on expert-adjudicated TEE We assessed the correlation between our variables using adjusted R2 model Results: Data of 42 patients was analyzed; Superior correlation was found between CT TR EROA and EROA on TEE (AdjR2 = 0.7) and CT IVC contrast reflux volume (AdjR2 = 0.4). A strong correlation was also demonstrated between TR EROA on TEE and TR Vena contracta and regurgitant volume on TEE (AdjR2 = 0.7and 0.4 respectively). There was no significant correlation between CT EROA and TR pre-procedure grading, TR VC on TEE and TR Regurgitant volume (AdjR2 = 0.04, 0.2 and 0.07 respectively). Conclusions: CT imaging plays a crucial role in the preprocedural planning of transcatheter tricuspid interventions, but its utility in assessing traditional echocardiographic severity metrics remains underexplored. We found a strong correlation between CT-based AROA and TEE-based tricuspid regurgitation EROA, suggesting that CT TR AROA could serve as a reliable reference standard for grading TR and guiding treatment decisions. Additionally, our study supports the use of CT-derived IVC contrast reflux volume as a valuable adjunct in assessing TR severity. The weaker correlation with expert TR grading further suggests that CT-based quantitative metrics may offer advantages over conventional echocardiographic integrative grading. [Formula presented]

Volume

19

Issue

4

First Page

S97

Last Page

S98

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