title: Excessive respiratory variation in tricuspid regurgitation systolic velocities in patients with severe tricuspid regurgitation.
abstract: OBJECTIVE
  Respiratory changes in tricuspid regurgitation (TR) systolic velocities are occasionally demonstrated by Doppler echocardiography in patients with TR. We tested the hypothesis that excessive respiratory changes in TR velocities are diagnostic of severe TR.
  
  
  RESULTS
  The difference between the maximal (expiratory) and minimal (inspiratory) TR systolic velocities during spontaneous respiration was measured by Doppler echocardiography in 68 patients with severe TR and 68 patients with moderate TR. The diagnostic value of the respiratory changes in TR velocity for detecting severe TR was assessed. The respiratory differences in TR velocities were greater in patients with severe TR (0.72 ± 0.30 m/s), compared with patients with moderate TR (0.28 ± 0.18; P < 0.001). Using receiver-operating characteristics analysis, the area under the curve for the respiratory difference in TR velocities for diagnosing severe TR was 0.92 (95% confidence interval: 0.87-0.96; P < 0.001). A difference in TR velocity ≥0.6 m/s had a sensitivity of 66%, specificity of 94%, positive predictive value of 92%, and a negative predictive value of 74% for diagnosing severe TR. Among patients with severe TR, excessive values of TR velocity difference were associated with signs of more severe TR (greater right ventricular size and malcoaptation of the tricuspid valve leaflets).
  
  
  CONCLUSIONS
  Excessive respiratory changes in Doppler measurements of TR systolic velocities are a specific sign of severe TR.
authors: Echocardiography Laboratory and Heart Valves Clinic, Department of Cardiology, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, P.O. Box 9602, Haifa 31096, Israel.
authors: Diab
authors: D
authors: Mutlak
authors: Shemy
authors: S
authors: Carasso
authors: Jonathan
authors: J
authors: Lessick
authors: Doron
authors: D
authors: Aronson
authors: Shimon A
authors: SA
authors: Reisner
authors: Yoram
authors: Y
authors: Agmon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012120:Respiration Disorders / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics; D018570:Risk Assessment; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Doppler; Echocardiography; Respiration; Tricuspid regurgitation