Assessment of the Peak Tricuspid Regurgitant Velocity from the Time Interval of the Retrograde Flow

Hyang Suk Yoon; Du Young Choi

doi:10.3803/jkes.1994.2.2.164

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Yoon and Choi: Assessment of the Peak Tricuspid Regurgitant Velocity from the Time Interval of the Retrograde Flow

Original Article

J Korean Soc Echocardiogr 1994;2(2):164-169.

Published online: 18 February 1994

DOI: https://doi.org/10.3803/jkes.1994.2.2.164

Assessment of the Peak Tricuspid Regurgitant Velocity from the Time Interval of the Retrograde Flow

Hyang Suk Yoon, M.D., Du Young Choi, M.D.

Department of Pediatrics, School of Medicine, Wonkwang University, Iri, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

A number of studies have demonstrated that an accurate measurement of the peak tricuspid regurgitation velocity with continuous wave Doppler, which may predict the right ventricular systolic pressure using the simplified Bernoulli equation. However, the peak velocities are often of low intensity on the spectral Doppler display if the tricuspid regurgitation(TR) is not severe. The aim of this study was to evaluate the usefulness of measuring the time interval from pulmonary closure to the end of tricuspid regurgitation, in predicting peak tricuspid regurgitant velocity and hence derive peak right ventricular systolic and pulmonary artery pressure (PAP).

Methods

We studied 19 patients with normal PAP (group A), and 7 with pulmonary hypertension(group B), 27 with postop state of the open cardiac surgery(group C). who underwent echocardiographic and Doppler assessment. Pulmonary elosure(PC) was taken as the closure artifact on the Doppler recording in the main pulmonary artery. Regurgitant flow was identified and recorded in continuous wave mode from the apex. The time interval from end of the TR to PC(TR end PC) was measured, and corrected by 100/min of heart rate.

Results

The time interval of corrected “TR and –PC” was 12.95 ± 48.69 msec in group A, 16.8 ± 43.15 msec in group C, where as 72.43 ± 37.71 msec in group B(p<0.01. comparing with group A). The correlation between TR end –PC and TR gradient was low in group A and C(r=0.12, 0.41 respectively), but high in group B(r=0.73)(TR gradient=0.55 ×TR end-PC + 29.1).

Conclusions

The time interval of TR end –PC in the patients with pulmonary hypertension was higher than normal subjects. And also, we found a good correlation between TR end –PC and TR gradient in patients with pulmonary hypertension. However, in postop state of the open cardiac surgery, there was no significant correlation. The precise explanations of this are by no means clear, but abnormal function of the right ventricle may affect the dynamics of regurgitant flow.

Keywords: Tricuspid regurgitation, Time interval, TR gradient.

References

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Fig. 1.

The method measuring a time interval from Q wave to end of the tricuspid regurgitation(Q-TR end)(A), from Q to pulmonary closure(Q-PC)(B).

Fig. 2.

The method measuring a tricuspid regurgitation gradient from the peak regurgitant flow velocity using a simplified Bernoulli equation.

Fig. 3.

Relationship between peak right ventricular-right atrial pressure gradient and the time interval from pulmonary closure(PC) to the end of tricuspid regurgitation(TR end –PC), for the patients with pulmonary hypertension.

Table 1.

Doppler echocardiographic estimates in three groups with tricuspid regurgitation

Groups	A[n=19]	B[n=7]	C[n=27]
age[yr]	4.88 ± 4.45	5.33 ± 4.84	5.05 ± 3.98
TR gradient(mmHg)	19.63 ± 7.46	64.38 ± 32.46^∗∗	23.5 ± 18.34^∗
Q-PC(msec)	362 ± 42.64	369.14 ± 38.96	375.64 ± 40.06
Q-TC(msec)	398.79 ± 40.06	462.2 ± 15.22^∗∗∗	404.19 ± 54.71^∗∗
TO-PC(msec)	36.79 ± 30.90	87.4 ± 35.80^∗	27.11 ± 33.40^∗
Q-TR end(msec)	365.42 ± 52.99	441.57144.47^∗∗	407.46 ± 78.87^∗
TR end–PC(msec)	4.11 ± 29.17	72.43 ± 37.71^∗∗	28.12 ± 42.39^∗

Values are mean± SD, Group B was compared with A, Group C was compred with B

^∗ : P<0.05,

^∗∗ : P<0.01,

^∗∗∗ : P<0.001

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