THE PATHOPHYSIOLOGY OF TRICUSPID REGURGITATION - ANALYSIS OF TRICUSPID-VALVE ANNULUS MOTION USING TWO-DIMENSIONAL ECHOCARDIOGRAPHY

  • 1 January 1985
    • journal article
    • research article
    • Vol. 74  (11) , 662-669
Abstract
We investigated tricuspid annular motion in patients with pulmonary hypertension and in normal controls to determine the greatest minimal diameter and percentage shortening of the tricuspid annulus required for functional tricuspid regurgitation. 73 patients were studied by 2-dimensional echocardiography: a control group of 30 patients (group I); 43 patients had pulmonary hypertension, 9 of whom were still in sinus rhythm (group II), the other 34 patients had atrial fibrillation. 19 of these showed competent tricuspid valve with contrast echocardiography (group III), whereas the 15 remaining patients had functional tricuspid regurgitation (group IV). An analysis of shape and position changes of tricuspid annulus during the heart cycle was performed. The maximal diameter (mm/m2) in the apical 4 chamber view was in group I 17.5 .+-. 1.4, in group II 20.7 .+-. 3.2 (vs group I p < 0.05), in group III 19.0 .+-. 3.4 (vs. group II NS) and in group IV 25.7 .+-. 6.0 (vs. group III p < 0.001). The values for the minimal annular diameter (mm/m2) were in group I 13.7 .+-. 1.2, in group II 17.4 .+-. 3.5 (vs group I p < 0.01), in group III 16.6 .+-. 3.3 (vs. group II NS) and in group IV 23.6 .+-. 5.7 (vs. group p < 0.001). The percent decrease (%) in group I was 21.5 .+-. 3.3, in group II 17.0 .+-. 6.9 (vs. group I p < 0.05), in group III 12.8 .+-. 4.7 (vs. group II p < 0.05) and in group IV 7.9 .+-. 3.4 (vs. group III p < 0.001). Atrial contraction was responsible for 63 .+-. 9% of annular shortening in group I and for 54 .+-. 9% in group II (vs. group I p < 0.01). Patients with pulmonary hypertension showed a larger tricuspid annulus. The elliptical shape of the tricuspid annulus and the asymmetric inward movement of the annular segment adjacent to the right ventricular free wall were almost identical in groups I and II. There was also no difference between these groups concerning position changes of tricuspid annulus during the heart cycle for maximal to minimal diameter. Considering a minimal annular diameter > 20 mm/m2 in the apical 4 chamber view and a reduced tricuspid annular percentage shortening < 11%, the sensitivity of these parameters in the detection of functional tricuspid regurgitation was 68-99%, specificity was 88-99% and predictive accuracy was 86-99%.