Clinical settings leading to presystolic tricuspid regurgitation.
OBJECTIVE
Few studies describe diastolic (presystolic) tricuspid regurgitation (DTR) mainly in the context of atrioventricular conduction abnormalities. Little is known about its occurrence in the other clinical settings.


METHODS
We identified patients with DTR recorded during routine echocardiographic examinations. DTR was defined as low velocity backward flow through the tricuspid valve orifice during end-diastole recorded with a continuous and/or pulsed-wave Doppler and/or color-coded M-mode Doppler echocardiography.


RESULTS
Diastolic tricuspid regurgitation was present in a wide variety of clinical entities. Of the 23 patients with DTR 6 patients had ischemic and 10 dilated cardiomyopathy. Others had clinical conditions including: inappropriate pacemaker settings, decompensated hypertrophic cardiomyopathy, biventricular dysfunction following orthotropic heart transplantation, torrential aortic regurgitation, low ejection fraction aortic stenosis, advanced endocardial fibroelastosis, and complex congenital heart disease. Twenty of 23 patients had significantly impaired right ventricle (RV) systolic function. Systolic tricuspid regurgitation was estimated as moderate or severe in 13 cases and mild in the remaining 10 cases. RV systolic pressure was significantly elevated in all but 2 cases. In all but 4 cases DTR was transient. The persistence of DTR was associated with severe pulmonary hypertension, severe biventricular failure, and persistent severe pulmonary regurgitation.


CONCLUSIONS
Diastolic tricuspid regurgitation may be encountered in a variety of clinical settings and should be sought for especially in patients with advanced RV systolic dysfunction, pulmonary hypertension, pulmonary regurgitation, or conduction abnormalities. Significant systolic regurgitation is not prerequisite for the development of DTR.
Echocardiographic Laboratory, Valvular Heart Disease Department, Warsaw, Poland.
Piotr
P
Szymański
Magdalena
M
Lipczyńska
Anna
A
Klisiewicz
Piotr
P
Hoffman
D000328:Adult; D000368:Aged; D054537:Atrioventricular Block / Q000150:complications* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011665:Pulmonary Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult
heart failure; right ventricle; tricuspid regurgitation