Background:Isolated tricuspid regurgitation (TR) remains a management dilemma with poor outcomes. Echocardiography and cardiac magnetic resonance imaging (CMR) are valuable tools for evaluating TR, but their prognostic utility has rarely been studied together in this setting. We aimed to determine the prognostic value and thresholds for echocardiography and CMR parameters for isolated severe TR.Methods:Consecutive patients with isolated severe TR by echocardiography and undergoing CMR during January 2007 to June 2019 were studied. Echocardiography and CMR-derived quantitative parameters were analyzed for independent associations with and thresholds for predicting the primary end point of all-cause mortality during follow-up.Results:Among 262 patients studied, mean age was 62.8±15.6 years, 156 (59.5%) were females, 207 (79.0%) had secondary TR, and 87 (33.2%) underwent tricuspid valve surgery after CMR. There were 68 (26.0%) deaths during a mean follow-up of 2.5 years. Both CMR-derived tricuspid regurgitant fraction (per 5% increase) and right ventricle free wall longitudinal strain (per 1% decrease in magnitude) were independently associated with worse survival, with hazard ratios (95% CIs) of 1.15 (1.05–1.25) and 1.10 (1.04–1.17), respectively, along with right heart failure symptoms of 2.03 (1.14–3.60), while tricuspid valve surgery was borderline protective with 0.55 (0.31–0.997). Regurgitant fraction ≥30%, regurgitant volume ≥35 mL and right ventricle free wall longitudinal strain ≥−11% (by velocity vector imaging technique, which yields lower magnitude values than other conventional strain techniques) were the optimal thresholds for mortality during follow-up.Conclusions:TR quantification by CMR and right ventricle free wall longitudinal strain by echocardiography were the key imaging parameters independently associated with reduced survival in isolated TR, incremental to conventional clinical factors. Clinically significant thresholds for these parameters were determined and may help guide decision-making for TR management.

中文翻译：

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补充超声心动图和磁共振成像定量评估对孤立性三尖瓣关闭不全的预后价值

背景：孤立性三尖瓣反流（TR）仍然是一个预后不良的管理困境。超声心动图和心脏磁共振成像 (CMR) 是评估 TR 的有价值的工具，但在这种情况下，它们的预后效用很少被一起研究。我们的目的是确定孤立性重度TR的超声心动图和CMR参数的预后价值和阈值。方法：对2007年1月至2019年6月期间连续进行超声心动图孤立性重度TR并接受CMR的患者进行研究。分析了超声心动图和 CMR 衍生的定量参数与预测随访期间全因死亡率的主要终点的独立关联和阈值。结果：在研究的 262 名患者中，平均年龄为 62.8±15.6 岁，156 (59.5%) ) 是女性，207 (79.0%) 人有继发性 TR，87 人（33.2%）在 CMR 后接受了三尖瓣手术。在平均 2.5 年的随访中，有 68 人（26.0%）死亡。CMR 衍生的三尖瓣反流分数（每增加 5%）和右心室游离壁纵向应变（每减少 1%）均与较差的生存率独立相关，风险比 (95% CI) 为 1.15 (1.05–1.25)和 1.10 (1.04-1.17)，以及 2.03 (1.14-3.60) 的右心衰竭症状，而三尖瓣手术具有临界保护性，为 0.55 (0.31-0.997)。反流分数 ≥30%、反流体积 ≥35 mL 和右心室游离壁纵向应变 ≥-11%（通过速度矢量成像技术，其产生的幅度值低于其他常规应变​​技术）是随访期间死亡率的最佳阈值.结论：通过 CMR 进行的 TR 量化和通过超声心动图进行的右心室游离壁纵向应变是与孤立的 TR 生存率降低独立相关的关键成像参数，增加了传统的临床因素。这些参数的临床意义阈值已确定，可能有助于指导 TR 管理的决策。