Tricuspid Regurgitation Assessment Using Cardiac Magnetic Resonance Velocity-Encoded 4-Dimensional Flow

• Published in: JACC. Case reports Vol. 30; no. 14; p. 103608
• Main Authors: Negm, Ahmed S., Sularz, Agata, Al-Abcha, Abdullah, El Shaer, Ahmed, Ponce, Alejandra Chavez, Collins, Jeremy D., Alkhouli, Mohamad
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 11.06.2025; Elsevier
• Subjects: 4D flow CMR; Cardiovascular; tricuspid regurgitation; Vascular Medicine; 4D; tricuspid regurgitation; RV; TTE; 4D flow CMR; RVEDV; CMR; TR; right ventricular; transthoracic echocardiography; cardiovascular magnetic resonance; 4-dimensional; right ventricular end-diastolic volume
• ISSN: 2666-0849; 2666-0849
• DOI: 10.1016/j.jaccas.2025.103608

Tricuspid regurgitation (TR) is a common valvular heart disease associated with right ventricular dysfunction and an increased risk of hospitalization because of heart failure. Accurate assessment of TR severity and right ventricular function is crucial for guiding management. We present 3 cases of TR evaluated with transthoracic echocardiography (TTE) cardiac magnetic resonance (CMR) with integrated 4-dimensional (4D) flow analysis. Case 1 demonstrated torrential TR on CMR, underestimated by TTE. Case 2 showed concordant findings across modalities. Case 3 revealed a discrepancy, with CMR suggesting mild-to-moderate TR and TTE indicated severe TR. Management decisions were guided by clinical status and multimodal imaging. This series highlights the limitations of TTE in TR assessment and the utility of CMR with integrated 4D flow analysis for accurate TR quantification. Integration of CMR with 4D flow analysis into the multimodal evaluation of TR provides valuable diagnostic information when TTE findings are discordant with clinical status or inadequate because of imaging constraints. [Display omitted]