{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T04:05:50Z","timestamp":1793419550942,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Tricuspid regurgitation (TR) is associated with increased mortality and is often underdiagnosed due to limitations in imaging modalities. While routine 2-dimensional echocardiography (2DE) demonstrates frequent disagreement with cardiac magnetic resonance imaging (CMR) in classifying TR severity, the incremental value of 3-dimensional echocardiography (3DE) remains unknown also due to the lack of a generalizable grading scheme across imaging modalities. Therefore, this study provides an intermodality comparison of all 3 imaging modalities (2DE, 3DE, and CMR) in evaluating TR severity and proposes an adapted 5-class grading scheme for TR severity using CMR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A total of 144 patients with symptomatic TR were analyzed across 2 cohorts: a derivation cohort (n=91) from the University Hospital of Munich and a validation cohort (n=53) from the Heart Center Leipzig. All patients underwent multimodality imaging, including transthoracic 2DE, transesophageal 3DE, and CMR. The adapted 5-class CMR-based grading scheme was proposed and externally validated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In the derivation cohort (median age 81 years, 66% female), TR severity grading by 3DE highly correlated with CMR (87% concordance within a 1-grade difference), significantly outperforming 2DE (68% concordance). While 3DE underestimated right ventricular dimensions compared with CMR (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), it provided a comparable measure of TR severity and right ventricular function. 2DE achieved the lowest accuracy rates compared with CMR (34.5%;\n              <jats:italic>P<\/jats:italic>\n              =0.005) with frequent overestimation of TR severity. An overestimation of TR severity by 3DE compared with CMR was significantly less frequent than with 2DE (21% versus 56%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Cohen \u03ba analysis confirmed a substantial and superior agreement between 3DE and CMR compared with 2DE (\u03ba=0.63 versus 0.41;\n              <jats:italic>P<\/jats:italic>\n              =0.01). The results were externally validated, showing comparable results within the derivation and validation cohorts.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>3DE provides an accurate assessment of TR severity comparable to CMR. The proposed 5-class grading scheme for TR severity using CMR demonstrates high accuracy and external validity.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.124.017638","type":"journal-article","created":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T09:18:34Z","timestamp":1742548714000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["3D Echocardiographic and CMR Imaging for the Assessment of Right Ventricular Function and Tricuspid Regurgitation Severity"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5700-4799","authenticated-orcid":true,"given":"Philipp M.","family":"Doldi","sequence":"first","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Munich, Germany (P.M.D., L.T.W., L.S., C.E., J.H.)."},{"name":"Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany (P.M.D., L.T.W., L.S., J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig T.","family":"Weckbach","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Munich, Germany (P.M.D., L.T.W., L.S., C.E., J.H.)."},{"name":"Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany (P.M.D., L.T.W., L.S., J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3089-9606","authenticated-orcid":true,"given":"Nicola","family":"Fink","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik f\u00fcr Radiologie, Ludwig-Maximilians-Universit\u00e4t Klinikum, Munich, Germany (N.F., J.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-1493","authenticated-orcid":true,"given":"Lukas","family":"Stolz","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Munich, Germany (P.M.D., L.T.W., L.S., C.E., J.H.)."},{"name":"Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany (P.M.D., L.T.W., L.S., J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Ennin","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Munich, Germany (P.M.D., L.T.W., L.S., C.E., J.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-6084","authenticated-orcid":true,"given":"Julien","family":"Dinkel","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik f\u00fcr Radiologie, Ludwig-Maximilians-Universit\u00e4t Klinikum, Munich, Germany (N.F., J.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5993-4487","authenticated-orcid":true,"given":"Philipp","family":"Lurz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (P.L., H.T., C.B.)."},{"name":"Zentrum f\u00fcr Kardiologie, Johannes Gutenberg-Universit\u00e4t, Mainz, Germany (P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-998X","authenticated-orcid":true,"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (P.L., H.T., C.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1342-9191","authenticated-orcid":true,"given":"Rebecca T.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University, Irving Medical Center, New York (R.T.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3632-2074","authenticated-orcid":true,"given":"Jo\u00e3o L.","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8082-6472","authenticated-orcid":true,"given":"Christian","family":"Besler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (P.L., H.T., 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