J Am Soc Echocardiogr. 2025 Oct 31:S0894-7317(25)00607-8. doi: 10.1016/j.echo.2025.10.015. Online ahead of print.
ABSTRACT
BACKGROUND: Three-dimensional echocardiographic (3DE) planimetry of the vena contracta area (VCA), which avoids geometric assumptions about the regurgitant orifice, has emerged as a promising method for grading secondary tricuspid regurgitation (STR). This study aimed to: (i) define VCA threshold values to grade the severity of STR using a five-grade system; (ii) identify the VCA cut-off value associated with adverse clinical outcomes; and (iii) assess the incremental prognostic value of VCA compared to conventional quantitative parameters of TR severity.
METHODS: We used 3DE to obtain VCA from 204 outpatients (77±12 years, 44% men) with mild to torrential STR (52%≥severe) according to current guidelines,and assessed its association with the composite outcome of all cause death and hospitalization for heart failure.
RESULTS: The VCA threshold values for STR severity were: <0.43 cm2 for mild, 0.43 cm2-0.67 cm2 for moderate, 0.68 cm2-0.88 cm2 for severe, 0.89 cm2-1.26 cm2 for massive, and >1.26 cm2 for torrential STR. Spline curve analysis identified a VCA threshold of 0.65 cm2 as the optimal cutoff associated with an increased risk of experiencing the composite endpoint. Although not yet severe, patients with VCA> 0.65 experience and exponential increase in their risk. VCA>0.65 cm2 was associated with a 3-fold risk increase for the composite endpoint regardless of effective regurgitant orifice area (EROA, log-rank p=0.00068). In multivariate analysis, VCA remained independently associated with the composite endpoint [aHR 1.06 (95% CI 1.02-1.10), p=0.004]. Adding VCA to baseline models incorporating clinical and echocardiographic variables, including either EROA or regurgitant volume (RegVol), significantly improved the prognostic performance of the model (p=0.007 and p=0.018, respectively).
CONCLUSION: VCA obtained from color Doppler 3DE is a robust parameter to grade STR severity, showing incremental prognostic value in comparison with both EROA and RegVol.
PMID:41177341 | DOI:10.1016/j.echo.2025.10.015