Diagnosis of tricuspid regurgitation. Sensitivity of Doppler ultrasound compared with contrast echocardiography

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Abstract
Fifty-one patients underwent Doppler studies of tricuspid flow and 2-D derived M-mode studies of the inferior vena cava (IVC) during upper extremity contrast injections. Tricuspid regurgitation (TR) was diagnosed with Doppler when reverse flow in systole was recorded at and behind the closure level of the tricuspid valve. TR was diagnosed with contrast ehocardiography (CE) when contrast appeared in the IVC between the onset of the QRS complex and the end of the T-wave of the ECG. Of the 49 patients who had TR diagnosed with Doppler, contrast was recorded in the IVC in 46, but only 18 (37%) fulfilled the criterion for a positive CE study. When the severity of the TR was semiquantitated with Doppler, CE diagnosed 1 of 25 mild, 5 of 11 moderate, and 12 of 13 severe regurgitations. When systolic contrast appearance in the IVC after the peak of the R-wave was used as the criterion for a positive contrast study, CE missed 2 of 13 severe regurgitations. In the 24 catheterized patients the CE study was positive only when an abnormal V-wave in the right atrial pressure curve was present. Doppler is a more sensitive method than CE for diagnosing TR and is more readily applied.