title: Evidence of tricuspid valve remodeling in patients with severe mitral regurgitation independently of degree of functional tricuspid regurgitation: a two- and three-dimensional echocardiographic study.
abstract: OBJECTIVE
  The study aim was to evaluate whether, in patients with severe mitral regurgitation (MR), tricuspid valve remodeling was independent of the degree of functional tricuspid regurgitation (FTR) present. Whether any differences in the analysis remodeling, as assessed by two-dimensional (2D) and three-dimensional (3D) echocardiography, can be demonstrated was also addressed.
  
  
  METHODS
  A total of 188 patients (mean age 63.5 +/- 16.0 years) with severe organic or functional MR with or without associated FTR, and 30 normal controls (mean age 59.2 +/- 15 years) were enrolled in the study. Subsequently, both 2D and 3D transthoracic anatomic and functional parameters of the tricuspid valve were analyzed.
  
  
  RESULTS
  Patients and controls differed in all 2D and 3D parameters of tricuspid valve remodeling, except for the 2D end-diastolic annular diameter and circularity indices. The patients were then allocated to either group A (trivial/mild FTR) or group B (moderate/severe FTR). Significant differences were identified between groups A and B compared to controls in all tricuspid valve remodeling indices, except for the diastolic 2D annular diameter and circularity indices. Groups A and B had similar 2D and 3D parameters of tricuspid valve remodeling. The right ventricular end-diastolic diameter (RVEDD) (beta = 0.24, 95% CI: 0.11 to 0.22, p = 0.02) and fractional area change (beta = -0.48, 95% CI: -0.24 to 0.09, p = 0.0001, R2 = 0.22) were independent predictors of the tenting area, whereas the RVEDD was the only independent predictor of the diastolic 3D tricuspid annular area (beta = 0.53, 95% CI: 1.2 to 2.7, p = 0.0001, R2 = 0.28).
  
  
  CONCLUSIONS
  In patients with severe MR, tricuspid valve remodeling was also demonstrated in those with trivial/mild FTR, but was better characterized by 3D echocardiography. Tricuspid valve remodeling and right ventricular dilation were the main determinants of tricuspid valve regurgitation.
authors: Eustachio
authors: E
authors: Agricola
authors: Giacomo
authors: G
authors: Ingallina
authors: Massimo
authors: M
authors: Slavich
authors: Vincenzo
authors: V
authors: Tufaro
authors: Luigi
authors: L
authors: Badano
authors: Michele
authors: M
authors: Oppizzi
authors: Andrea
authors: A
authors: Fisicaro
authors: Alberto
authors: A
authors: Margonato
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery