September 28, 2010Circulation
Pathophysiology of Tricuspid Regurgitation
Key result
Inspiration significantly increased effective regurgitant orifice (median increase 0.21 cm2) and regurgitant volume (18 mL/beat) in patients with tricuspid regurgitation (all P<0.001).
Population
41 patients with mild or greater tricuspid regurgitation (TR), median age 67 years.
Comparison
Triple Doppler echocardiographic quantification… vs Within-subject comparison
Design
Cross-sectional
Authors
Discussion
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Implication
TR severity grading should account for respiratory phase; leaves open need for standardized protocols and outcome validation.
Key Points
- The aim was to clarify the respiratory dependence mechanisms of tricuspid regurgitation (TR) and its clinical impact.
- Involved 41 patients with mild or greater TR and triple Doppler echocardiography quantification.
- Simultaneous respirometer recording of respiratory phases was performed during assessments.
- Quantified changes in TR peak velocity, duration, and effective regurgitant orifice across respiratory phases.
- TR peak velocity changed by −40 cm/s and effective regurgitant orifice increased by 0.21 cm² during inspiration (P<0.001).
- Inspiratory changes increased right ventricular area while decreasing the valvular-to-annular ratio (P<0.0001).
- Right ventricular shape widening correlated with effective regurgitant orifice enlargement, suggesting dynamic TR behavior with respiratory influences.
Study Design
Type
Observational (n=41)
Structured PICO
P
Population
41 patients with mild or greater tricuspid regurgitation (TR), median age 67 years.
I
Intervention
Triple Doppler echocardiographic quantification with simultaneous respirometer recording of respiratory phases
C
Comparator
Within-subject comparison (expiration versus inspiration)
O
Outcome
Expiration to inspiration changes in TR peak velocity, duration, time-velocity integral, effective regurgitant orifice, and regurgitant volumesurrogate
Main Result
p-value: p=<0.001
Tricuspid regurgitation is highly dynamic, with inspiration causing a significant increase in effective regurgitant orifice and volume driven by right ventricular shape widening and annular enlargement.
Cite This Study
Topilsky et al. (2010) conducted an observational in Mild or greater tricuspid regurgitation (n=41). Inspiration vs. Expiration was evaluated on Expiration to inspiration changes in tricuspid regurgitation peak velocity, duration, and time-velocity integral (p=<0.001). Inspiration significantly increased effective regurgitant orifice (median increase 0.21 cm2) and regurgitant volume (18 mL/beat) in patients with tricuspid regurgitation (all P<0.001).