Echocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation.
BACKGROUND
The etiology of functional tricuspid regurgitation (TR) is thought to be annular dilatation and tethering of tricuspid valve (TV) leaflets. However, mechanisms of leaflet tethering are incompletely understood. The purpose of this study was therefore to investigate the relationships between TV annular dilatation and leaflet tethering with the severity of functional TR and to investigate factors that influence these TV deformations.


METHODS
Two hundred forty-five patients with functional TR had 2-dimensional echocardiography. Echocardiographic investigations focused on the ventricles and on the TV. Ventricular measurements included left ventricular (LV) volume, right ventricular (RV) area, and RV spherical index. Valvular measurements included systolic TV annular dimension and apical displacement (tethering height), as well as severity of TR (vena contracta width).


RESULTS
Tethering height (r2 = 0.25) was related to the severity of TR (P < .001). The RV and right atrium areas influenced both annular dimension and tethering height. However, LV ejection fraction and RV spherical index affected tethering height but not annular dimension.


CONCLUSIONS
Tethering of TV leaflets, a determinant of functional TR, is associated with changes in right-sided cavity size as well as RV sphericity and LV function, emphasizing the impact of changes in ventricular geometry and function on the severity of functional TR.
Fukuda
Shota
S
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Gillinov
A Marc
AM
Song
Jong-Min
JM
Daimon
Masao
M
Kongsaerepong
Vorachai
V
Thomas
James D
JD
Shiota
Takahiro
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D006321:Heart / Q000503:physiopathology*; D006325:Heart Atria; D006352:Heart Ventricles; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D012720:Severity of Illness Index; D013249:Sternum / Q000000981:diagnostic imaging; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016277:Ventricular Function, Left