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  • Title: Predominant Posterior Annular Dilatation Is Associated with Vena Contracta Morphology in Atrial Functional Tricuspid Regurgitation.
    Author: Utsunomiya H, Yoshida J, Izumi K, Takemoto H, Ueda Y, Nakano Y, Shiota T.
    Journal: J Am Soc Echocardiogr; 2022 Jun; 35(6):588-599. PubMed ID: 35091070.
    Abstract:
    BACKGROUND: The exact relationship between tricuspid valve geometry and vena contracta (VC) morphology has pathophysiologic and mechanistic implications in patients with atrial functional tricuspid regurgitation (AF-TR). The aim of this study was to investigate tricuspid valve geometric and VC morphologic characteristics and compare them between AF-TR and ventricular functional tricuspid regurgitation (VF-TR) in sinus rhythm. METHODS: Transesophageal three-dimensional echocardiography data sets of the tricuspid valve were acquired in 439 patients with moderate to severe tricuspid regurgitation. Forty-eight patients with AF-TR and 48 with VF-TR in sinus rhythm matched for age, sex, body surface area, and VC area according to three-dimensional echocardiography-based pathogenic stratification were selected. VC morphology was determined by the ratio of anteroposterior to anterolateral-posteromedial diameter using color Doppler three-dimensional echocardiography. RESULTS: Patients with AF-TR had higher posterior annular perimeter/total annular perimeter ratios than patients with VF-TR in sinus rhythm (P < .001). Despite similar VC areas, patients with AF-TR had larger VC anteroposterior diameters and smaller VC anterolateral-posteromedial diameters, with resultant higher VC anteroposterior/anterolateral-posteromedial diameter ratios (P < .001). On multivariable analyses, posterior annular perimeter (coefficient = 0.013; 95% CI, 0.001 to 0.024) and posterior leaflet length/annular perimeter ratio (coefficient = -2.372; 95% CI, -3.591 to -1.154) were multivariable determinants of VC morphology in AF-TR. Additionally, posterior annular perimeter/total annular perimeter was strongly related to right atrial volume in AF-TR but not in VF-TR. CONCLUSIONS: Possible contributions to the initial mechanism of AF-TR include right atrial remodeling, predominant posterior annular dilatation, and insufficient adaptive posterior leaflet growth, which may have therapeutic implications in this setting.
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