BACKGROUND Tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in an apical four-chamber view on two-dimensional (2D) transthoracic echocardiography (TTE). We performed a combined 2D and three-dimensional (3D) echocardiographic study to understand the impact of the size, shape, and orientation of a dilated annulus on the inconsistencies between measured 2D TTE-TAD and the actual annular diameter. METHODS A total of 185 patients with grade ≥3+ TR and 50 controls underwent 2D TTE and 3D transesophageal echocardiography (TEE) assessment of the tricuspid valve. The 3D TEE-TAD, defined as the longest dimension, and tricuspid annulus (TA) eccentricity index, defined as the shortest/longest dimension ratio, were obtained. The angle between the major tricuspid annulus axis and interatrial septum parallel to the vertical axis (α°) was measured as an index of TA orientation. RESULTS Compared with controls, TR subgroups had a larger α° irrespective of TR etiology and cardiac rhythm (P < .05), with the posteriorly displaced TA most frequently noted in patients with atrial fibrillation. An excellent correlation was found between 3D TEE-TAD and 2D TTE-TAD, but 2D TTE-TAD was significantly smaller than 3D TEE-TAD (35.9 ± 5.4 vs 39.8 ± 5.7 mm; P < .001; bias, 3.9 ± 2.6 mm; limits of agreement, -1.1-8.9 mm). After multivariate adjustment, a larger 3D TEE-TAD and larger absolute value of 90° - α° were independent determinants of the bias between 3D TEE-TAD and 2D TTE-TAD (both P < .001). CONCLUSIONS The inconsistencies between measured 2D TTE-TAD and the actual annular diameter can be explained through morphologic factors such as TA size and orientation.

中文翻译：

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通过三维超声心动图评估三尖瓣反流中三尖瓣环的大小，形状和方向的临床影响。

背景技术用于三尖瓣关闭不全（TR）的三尖瓣瓣环成形术取决于在二维（2D）经胸超声心动图（TTE）的心尖四腔视图中获得的三尖瓣环直径（TAD）的测量值。我们进行了二维和三维（3D）超声心动图研究，以了解膨胀环的尺寸，形状和方向对测量的二维TTE-TAD与实际环形直径之间的不一致的影响。方法总共185例≥3+ TR的患者和50名对照接受了三尖瓣的2D TTE和3D经食管超声心动图（TEE）评估。获得了定义为最长尺寸的3D TEE-TAD和定义为最短/最长尺寸比的三尖瓣环（TA）偏心指数。测量三尖瓣主瓣环轴与房间隔平行于垂直轴（α°）的夹角，作为TA方向的指标。结果与对照组相比，无论TR病因和心律如何，TR亚组的α°都较大（P <.05），在房颤患者中最常出现后移位TA。在3D TEE-TAD和2D TTE-TAD之间发现了极好的相关性，但2D TTE-TAD显着小于3D TEE-TAD（35.9±5.4 vs 39.8±5.7 mm; P <.001;偏斜，3.9±2.6 mm ；协议限制为-1.1-8.9毫米）。经过多变量调整后，较大的3D TEE-TAD和较大的90°-α°绝对值是3D TEE-TAD和2D TTE-TAD之间偏差的独立决定因素（均P <0.001）。