Association with Outcomes of Correcting the PISA Method to Quantitate Secondary Tricuspid Regurgitation.

Abstract

Background: Although the correction of the proximal isovelocity surface area (PISA) method has been shown to improve the accuracy of assessing the severity of secondary tricuspid regurgitation (STR), its clinical impact remains to be investigated.

Objectives: To compare the association of the quantitative parameters of STR severity obtained from the corrected and conventional PISA methods with the outcome.

Methods: We measured both conventional and corrected effective regurgitant orifice area [EROA vs. corrected EROA (EROAc)], regurgitant volume [RegVol vs. corrected RegVol (RegVolc)], and regurgitant fraction [RegFr vs. corrected RegFr (RegFrc)] in 519 consecutive patients (75±12 years, 44% men, 74% ventricular) with moderate and severe STR. The endpoint was a composite of heart failure hospitalization and death.

Results: EROAc, RegVolc, and RegFrc were significantly larger than EROA, RegVol, and RegFr (P < 0.001 for all). After a follow-up of 19±15 months, 210 patients reached the endpoint. Using time-dependent ROC curves, the parameters obtained from the corrected PISA were more closely associated with outcomes at two years than those obtained with the conventional PISA: EROAc vs. EROA (p<0.001), RegVolc vs. RegVol (p=0.001), and RegFrc vs. RegFr (p<0.001) in ventricular STR. Conversely no significant differences were detected in atrial STR. After multivariable adjustment, both uncorrected and corrected EROA, RegVol, and RegFr were independently associated with the endpoint. Using the new 5-grade severity scheme, patients reclassified by corrected PISA method had a significantly higher rate of events compared to those not reclassified in with V-STR (p = 0.0086). Conversely, this relationship was not statistically significant in patients with atrial STR (p = 0.061) CONCLUSIONS: Correcting the PISA method provides larger quantitative parameters of STR severity that are more closely associated with outcomes in patients with ventricular STR.