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Quantification of tricuspid regurgitation using two-dimensional velocity encoding cine: optimal plane and reproducibility

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Abstract

To determine the optimal plane of two-dimensional velocity-encoding cine (VENC) magnetic resonance (MR) imaging at the tricuspid annulus for quantification of tricuspid regurgitation (TR) and to assess the reproducibility of VENC tricuspid flow measurements. We conducted a retrospective review of MR images of 25 consecutive patients (M:F = 8:17; mean age, 58.5 ± 10.5 years) with TR. VENC was performed twice orthogonal to the tricuspid annulus plane during the end-diastolic (ED) and end-systolic (ES) phases. The TR fraction was quantified at each plane as retrograde flow/antegrade flow and additionally as retrograde flow of the ED plane/antegrade flow of the ES plane (combined plane method). The conventional method to determine the TR amount [right ventricular stroke volume (RVSV)—pulmonary antegrade flow] and TR fraction (TR amount/RVSV) was used as the reference standard. There were no differences between TR amount and retrograde flow of the ED plane (65.3 ± 43.4 vs. 70.5 ± 36.1 ml, P = 0.361) between the RVSV and the antegrade flow of the ES phase (124.2 ± 46.1 vs. 128.0 ± 45.0 ml, P = 0.612) or in TR fraction between the conventional and combined plane methods (48.8 ± 19.2 vs. 56.3 ± 24.3 %, P = 0.08). The retrograde flow of the ED phase was best correlated with TR amount [intraclass correlation coefficient (ICC) = 0.859] and antegrade flow of ES with RVSV (ICC = 0.808). The TR fraction of the combined plane method was best correlated with the conventional method (ICC = 0.694). Interobserver agreement of VENC flow measurements was excellent (ICC, 0.939–0.993). The optimal method for quantification of TR using tricuspid annular VENC was the combined plane method, which divides the retrograde flow of the ED plane by the antegrade flow of the ES plane. Tricuspid flow measurements using VENC showed excellent reproducibility.

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Abbreviations

2D:

Two-dimensional

CI:

Confidence interval

ECG:

Electrocardiogram

ED:

End-diastolic

EDV:

End-diastolic volume

EF:

Ejection fraction

ES:

End-systolic

ESV:

End-systolic volume

ICC:

Intraclass correlation coefficient

LPA:

Left pulmonary artery

MR:

Magnetic resonance

RPA:

Right pulmonary artery

RV:

Right ventricular

RVSV:

Right ventricular stoke volume

SV:

Stroke volume

TR:

Tricuspid regurgitation

TrueFISP:

True fast imaging with steady-state precession imaging

VENC:

Velocity-encoding cine

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Korea

    Hoyong Jun, Eun-Ah Park, Whal Lee & Jin Wook Chung

  2. Department of Radiology, Dongsan Medical Center, Keimyung University, Daegu, Korea

    Young Eun Bahn

  3. Cardiovascular Division, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

    Hyung-Kwan Kim

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  1. Hoyong Jun
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  2. Eun-Ah Park
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  4. Whal Lee
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Correspondence to Eun-Ah Park.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. Our institutional review board approved this retrospective study design and waived the requirement for informed consent.

Electronic supplementary material

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10554_2015_715_MOESM1_ESM.avi

Supplementary material 1 Movie 1 Velocity map of velocity-encoding cine obtained orthogonal to the tricuspid annulus at the moment of end diastole. Regurgitant tricuspid flow, shown as a black signal, is well visualized during systole (AVI 4053 kb)

10554_2015_715_MOESM2_ESM.avi

Supplementary material 2 Movie 2 Velocity map of velocity-encoding cine obtained orthogonal to the tricuspid annulus at the moment of end systole. Tricuspid inflow, which is shown as a white signal, is well visualized during diastole (AVI 4053 kb)

Supplementary material 3 Movie 3 Demonstration of tricuspid transannular motion during the cardiac cycle on a short-axis cine image orthogonal to the tricuspid annulus during the moment of the end-diastolic phase (AVI 678 kb)

Supplementary material 4 Movie 4 Demonstration of tricuspid transannular motion during the cardiac cycle on a short-axis cine image orthogonal to the tricuspid annulus during the moment of the end-systolic phase (AVI 663 kb)

Supplementary material 5 Movie 5 Demonstration of tricuspid transannular motion during the cardiac cycle on a four-chamber cine image. The yellow line represents the tricuspid annular end-diastolic plane, and the red line indicates the tricuspid annular end-systolic plane (AVI 718 kb)

Supplementary material 6 Movie 6 Demonstration of tricuspid transannular motion during the cardiac cycle on a right ventricular two-chamber cine image. The yellow line indicates the tricuspid annular end-diastolic plane, and the red line represents the tricuspid annular end-systolic plane (AVI 666 kb)

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Jun, H., Park, EA., Bahn, Y.E. et al. Quantification of tricuspid regurgitation using two-dimensional velocity encoding cine: optimal plane and reproducibility. Int J Cardiovasc Imaging 31 (Suppl 2), 233–240 (2015). https://doi.org/10.1007/s10554-015-0715-x

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  • DOI: https://doi.org/10.1007/s10554-015-0715-x

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