Clinical Investigation
Quantitation of Tricuspid Regurgitation
Sources of Variability in Vena Contracta Area Measurement for Tricuspid Regurgitation Severity Grading: Comparison of Technical Settings and Vendors

https://doi.org/10.1016/j.echo.2020.10.015Get rights and content
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Highlights

  • VCA measurement in TR is sensitive to technical factors.

  • Intervendor agreement of VCA measurement in TR is poor.

  • Technical settings, vendors and reference methods affect VCA cut-offs for severe TR.

Background

Previous studies found different cutoffs of vena contracta area (VCA) to define severe tricuspid regurgitation (TR). The aim of this study was to investigate the factors associated with such variability by comparing technical variables and vendors.

Methods

Sixty-nine patients with scheduled tricuspid surgery were included in this prospective study. For each patient, TR data sets were obtained on three-dimensional color Doppler transthoracic echocardiography on at least two of three systems: GE Vivid E95 (n = 39), Siemens SC2000 Prime (n = 64), and Philips EPIQ 7C (n = 60). VCA was measured using default settings or with color baseline shifted on all three platforms and with minimal color gain (10%–20%) on the GE platform.

Results

Color gain reduction and baseline shift caused significant change sin VCA measurement (−46% and 10%, respectively). Intervendor comparison exhibited wide limits of agreement (narrowest range, −74% to 167%), with either default or optimized settings. Different technical settings, platforms, and reference methods all produced different VCA cutoffs for severe TR.

Conclusions

VCA measurement in TR is sensitive to technical factors and demonstrates intervendor variability. Technical variables in VCA measurement should be reported in detail to allow comparison among research studies. The same vendor and settings should be used for longitudinal analysis of TR VCA in the same patient in multivendor echocardiography laboratories.

Keywords

Tricuspid regurgitation
Vena contracta
Effective regurgitant orifice
Reproducibility

Abbreviations

2D
Two-dimensional
3D
Three-dimensional
CDE
Color Doppler echocardiography
EROA
Effective regurgitant orifice area
LOA
Limits of agreement
RVol
Regurgitant volume
RVOT
Right ventricular outflow tract
SV
Stroke volume
TR
Tricuspid regurgitation
VCA
Vena contracta area
VCW
Vena contracta width

Cited by (0)

This work was supported by the National Natural Science Foundation of China (grant 81771837), the Shanghai Committee of Science and Technology (grant 17411962400), the Clinial Research Plan of Shanghai Hospital Development Center (grant SHDC2020CR4071) and the Shanghai "Rising Stars of Medical Talent" Youth Development Program (Youth Medical Talents - Medical Imaging Practitioner Program) [grant SHWRS(2020)_087].

Conflicts of Interest: None.