Tricuspid valve remodelling in functional tricuspid regurgitation: multidetector row computed tomography insights

Aims Multidetector row computed tomography (MDCT) may help to understand the underlying mechanisms of functional tricuspid regurgitation (TR), a highly prevalent valve disease with novel transcatheter therapies under development. The purpose of the present study was to assess the geometrical changes of the tricuspid valve in patients with functional TR using MDCT and to correlate these changes with the TR grade assessed with echocardiography. Methods and results In 114 patients undergoing transcatheter aortic valve implantation (47 men, age 81 +/- 8 years), including 33 (28.9%) patients with TR >= 3+, the tricuspid valve and right ventricle (RV) were geometrically analysed with 320-slice MDCT. The antero-posterior and septal-lateral diameters, perimeter and area of the annulus, degree of tethering of the anterior, septal and posterior tricuspid valve leaflets, and RV volumes and ejection fraction were assessed and subsequently correlated with TR grade in multivariate models. Patients with pacemaker or implantable cardioverter defibrillator leads were excluded. Patients with TR >= 3+ had larger tricuspid annulus area (1539.7 +/- 260.2 vs. 1228.4 +/- 243.5 mm(2), P < 0.001), larger septal and anterior leaflet angles, and larger RV end-systolic volumes (93.2 +/- 29.8 vs. 64.2 +/- 23.6 mL, P < 0.001) compared with patients with TR, 3+. The antero-posterior tricuspid annulus diameter was independently correlated with TR >= 3+ (odds ratio 1.35; 95% confidence interval 1.07-1.69, P < 0.010), after adjusting for estimated pulmonary pressure and RV end-systolic volume. Conclusion In patients with TR >= 3+, MDCT demonstrated larger tricuspid annulus and RV dimensions and pronounced tethering of the anterior and septal tricuspid leaflet. The antero-posterior annulus diameter was independently correlated with the grade of functional TR.