Three-Dimensional Transthoracic Echocardiography for Semiautomated Analysis of the Tricuspid Annulus: Validation and Normal Values

• Published in: Journal of the American Society of Echocardiography Vol. 38; no. 1; pp. 33 - 43.e3
• Main Authors: Cotella, Juan I., Blitz, Alexandra, Clement, Alexandra, Tomaselli, Michele, Muraru, Denisa, Badano, Luigi P., Sauber, Natascha, Font Calvarons, Adria, Degel, Markus, Rucki, Agnieszka, Blankenhagen, Michael, Yamat, Megan, Schreckenberg, Marcus, Addetia, Karima, Asch, Federico M., Mor-Avi, Victor, Lang, Roberto M., Prado, Aldo D., Filipini, Eduardo, Ronderos, Ricardo E., Samantha Hoschke-Edwards, Agatha Kwon, Scalia, Gregory M., Afonso, Tania Regina, Tude Rodridugues, Ana Clara, Thampinathan, Babitha, Sooriyakanthan, Maala, Tsang, Wendy, Wang, Yingbin, Zhang, Yu, Zhu, Tiangang, Wang, Zhilong, Alagesan, R., Balasubramanian, S., Ananth, R.V.A., Amuthan, Vivekanandan, Bansal, Manish, Kasliwal, Ravi R., Alizadehasl, Azin, Sadeghpour, Anita, Bossone, Eduardo, Nakao, Tomoko, Kawata, Takayuki, Hirokawa, Megumi, Sawada, Naoko, Daimon, Masao, Nabeshima, Yousuke, Takeuchi, Masaki, Fajardo, Pedro Gutierrez, Ogunyankin, Kofo O., Tucay, Edwin S., Yun, Hye Rim, Park, Seung Woo, Hwang, Ji-won, Monaghan, Mark J., Kirkpatrick, James N., Miyoshi, Tatsuya
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2025
• Subjects: 3D echocardiography; Adult; Aged; Algorithms; Cardiovascular; Echocardiography, Three-Dimensional - methods; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Pattern Recognition, Automated - methods; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Tricuspid valve; Tricuspid Valve - diagnostic imaging; Tricuspid Valve Insufficiency - diagnostic imaging; TV; RV; TTE; ICC; CoV; TA; ES; MPR; AP; RA; 3D; BSA; 2D; 3DE; WASE; SL; 3D echocardiography; Tricuspid valve; TR; ED; Right atrial; Two-dimensional; Multiplanar reconstruction; Septolateral; Tricuspid regurgitation; Coefficient of variation; World Alliance Societies of Echocardiography; Tricuspid annular; Anteroposterior; End-systole; Body surface area; Intraclass correlation coefficient; Transthoracic echocardiography; Three-dimensional echocardiography; End-diastole; Three-dimensional; Right ventricular
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2024.09.007

The expansion of tricuspid valve (TV) interventions has underscored the need for accurate and reproducible three-dimensional (3D) transthoracic echocardiographic (TTE) tools for evaluating the tricuspid annulus and for 3D normal values of this structure. The aims of this study were to develop new semi-automated software for 3D TTE analysis of the tricuspid annulus, compare its accuracy and reproducibility against those of multiplanar reconstruction (MPR) reference, and determine normative values. Three-dimensional TTE images of 113 patients with variable degrees of tricuspid regurgitation were analyzed using the new semiautomated software and conventional MPR methodology (as the reference standard), each by three independent readers. For each measured parameter, intertechnique agreement was assessed using linear regression and Bland-Altman analyses, and interreader variability using intraclass correlation coefficients and coefficients of variation. Additionally, 3D TTE data sets of 789 subjects from the WASE (World Alliance Societies of Echocardiography) study were analyzed using this new software to determine normal values for each tricuspid annular (TA) parameter. Semiautomated measurements showed excellent agreement with MPR reference values for all TA measurements: high correlations (all r values >0.8) and minimal biases. All measurements were more reproducible than with MPR: higher intraclass correlation coefficients (0.94-0.96 vs 0.82-0.90) and lower coefficients of variation (5%-12% vs 8%-18%). Sex- and age-related differences were identified in 3D normal values of most TA parameters. Dynamic analysis showed that TA parameters vary throughout the cardiac cycle, reaching minimal values at end-systole and maximum values in late diastole. Novel software for semiautomated analysis of TA geometry and dynamics provides accurate and reproducible measurements. Normal values of TA dimensions, parsed by sex and age, are reported. XXX. [Display omitted] •The authors developed semiautomated software for analysis of the tricuspid annulus.•Its accuracy and reproducibility were compared against MPR.•All measurements showed excellent agreement with and better reproducibility than MPR.•Normal values parsed by sex and age were derived from 789 WASE subjects.