title: A new and simple method for clarifying the severity of tricuspid regurgitation.
abstract: BACKGROUND
  No gold standard exists for grading tricuspid regurgitation (TR) severity. We developed a simple parameter, the right ventricular (RV) early inflow-outflow (RVEIO) index, using the early diastolic filling velocity and RV outflow velocity integrated over the systolic ejection period. We hypothesized that this index would help identify severe TR in clinical practice.
  
  
  METHODS
  We obtained data from routine transthoracic echocardiograms. All records reporting moderate (n=395) or severe (n=395) TR were reanalyzed to measure vena contracta (VC) width, TR jet area, effective regurgitant orifice (EROA) derived with the proximal isovelocity surface area method, RVEIO index, and right-sided chamber volumes.
  
  
  RESULTS
  Significant linear trends were demonstrated for right atrial volume index, end-diastolic volume index, E-wave velocity, RV velocity time integral, TR jet area, VC width, and EROA with increasing TR severity. Independent predictors of severe RT included RVEIO index ≥ 10, VC width ≥ 0.7 cm, TR jet area>10 cm2, and EROA ≥ 0.4 cm2.
  
  
  CONCLUSIONS
  RVEIO index is a useful, simple, accurate, and independent predictor of severe TR that adds incrementally to traditional methods of quantifying TR severity. Accurate quantification and classification of TR severity is critical for clinical decision-making and management; therefore, the incorporation of RVEIO index into the integrative approach to grading TR severity should be considered.
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ibrahim Akin
authors.initials: IA
authors.lastname: Izgi
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Emrah
authors.identifier: http://orcid.org/0000-0001-8535-2336
authors.initials: E
authors.lastname: Acar
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Alev
authors.initials: A
authors.lastname: Kilicgedik
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Guler
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Ender Ozgun
authors.initials: EO
authors.lastname: Cakmak
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Muhittin
authors.initials: M
authors.lastname: Demirel
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Izci
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Yilmaz
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Inanir
authors.affiliation: Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
authors.forename: Cevat
authors.initials: C
authors.lastname: Kirma
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*
keywords: Doppler; echocardiography; tricuspid regurgitation; tricuspid valve