Clinical InvestigationValvular and Congenital Heart DiseaseEchocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation
Section snippets
Patients
A total of 384 consecutive patients with functional TR who had transthoracic 2-dimensional echocardiography initially enrolled from the Cleveland Clinic Foundation echocardiography database, which was approved by the Institutional Review Board for clinical research. Functional TR was defined as (1) >2+ TR on the clinical echocardiographic report based on a scale of 0 to 4+, (2) without any organic TV diseases, and (3) no history of prior TV surgery. Patients with congenital heart disease (n =
Characteristics
Echocardiographic results in patients with TR and in controls were summarized in Table I.
Relationship between TR severity and echocardiographic parameters
In the univariate analysis, TR severity (VCW) was correlated with RV systolic area, RV long-axis dimension, RV spherical index, RA area, TV annular dimension, and tethering height as shown in Table II. When these 6 parameters were entered into the stepwise multivariate regression analysis, RV spherical index (P = .03), RA area (P < .001), and tethering height (P < .001) were significant factors.
In
Key findings
This study emphasizes the importance of leaflet tethering on the pathogenesis of functional TR. Tethering of the TV leaflets is sufficient to cause TR even in the absence of significant TV annular dilatation. Tethering of TV leaflets is associated with changes in right-sided cavity size, RV sphericity, and LV function, demonstrating the impact of changes in ventricular geometry and function on the pathogenesis of functional TR.
Impact of tethering of TV leaflets on the severity of functional TR
Previous echocardiographic and angiographic studies reported that RV
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Disclosures: Dr Gillinov has served as consultant to Edwards Lifesciences, LLC.