Diagnosis of functional tricuspid insufficiency by pulsed-wave Doppler ultrasound.

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Abstract
Healthy subjects (24) and patients (33) with left-sided valvular heart disease in atrial fibrillation were studied with a pulsed-wave Doppler ultrasound system connected to a 90.degree. two-dimensional echocardiography device. Systolic turbulence in the right atrium (RAST) was studied, and the ratio of maximum systolic velocity to maximum diastolic velocity ratio (MSV:MDV) was determined in the superior vena cava. In the 33 patients with valvular disease, right ventricular angiography was performed, classifying tricuspid insufficiency (TI) in 31 cases as absent, mild or moderate-to-severe. In 2 cases, right ventricular angiography was inconclusive. In all of the healthy subjects, right atrial flow could be analyzed, and no RAST was found. In the group with valvular heart disease, no interpretable signs of right atrial flow were found in 3 patients. RAST was found in all 14 patients who had moderate-to-severe TI and in 3 of 7 who had mild TI; none of the patients without TI had RAST (pretest likelihood 68%, sensitivity 81%, specificity 100% and positive predictive value 100%). No relationship could be demonstrated between the intensity of RAST and the severity of TI. The flow pattern in the superior vena cava could be analyzed in all 57 patients. The MSV:MDV ratio was > 1 in all the healthy subjects and < 1 in the 31 patients. MSV was negligible (MSV < 1:3 MDV) in the 15 patients with moderate-to-severe TI, in 4 of the 7 patients with mild TI, and in 2 of the 8 without TI. Using a MSV:MDV < 1:3 to differentiate, sensitivity was 83% and specificity 77% and the positive predictive value was 90%. Pulsed-wave Doppler ultrasound examination in patients with valvular heart disease is a highly specific means of diagnosing functional TI and is probably useful for identifying patients with severe functional TI. However, sensitivity is lower for mild TI.