ASSESSING RIGHT ATRIAL SIZE IN PATIENTS WITH TRICUSPID REGURGITATION: IMPORTANCE OF THE RIGHT VENTRICULAR-FOCUSED VIEW

AIMS: To assess the accuracy of measuring the right atrial volume (RAV) using two-dimensional echocardiography (2DE) in a right ventricular focused (RVF) view compared tothe conventional apical 4-chamber (4Ch) view in patients with secondary tricuspidregurgitation (STR). We also compared the clinical correlates of the measures obtainedusing different methods.METHODS AND RESULTS: The accuracy of RAV measurements obtained from 2DE-4Ch and RVF views in 384 patients with STR were compared using three-dimensionalechocardiography (3DE) as a reference. We used the analysis of variance to test thedifferences among RAVs obtained from the different 2DE and 3DE acquisitions and thereceiving operating characteristics (ROC) curves to evaluate the association with thecomposite endpoint of hospitalization for heart failure or death. Compared to 3DE, RAV wassignificantly more underestimated when measurements were obtained from 4Ch rather thanRVF (-24% vs. -14%, respectively, p<0.001 for both). RAV underestimation in 4Ch and RVFview was relatively larger in lower grades of STR (-28% vs. -17% in mild, -23% vs. -14% inmoderate, and -19% vs. -11% in severe STR, p=0.001), and in the atrial compared toventricular (-28% vs. -22%; p=0.002) STR. RAV measured by 3DE and RVF showed thehighest area under the curve (AUC=0.67 for 3DE vs 0.64 for RVF, p=0.05), while 4Ch wassignificantly less related to the outcomes (AUC: 0.61, p=0.021 vs 3DE RAV).CONCLUSIONS. In patients with STR, the use of RVF view improved the accuracy of2DE RAV measurement as compared to the conventional 4Ch-derived measurements.