Vaturi Mordehay, Shapira Yaron, Vaknin-Assa Hana, Oron Aviv, Matesko Revital, Sagie Alex
Dan Scheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
J Heart Valve Dis. 2003 Mar;12(2):197-201.
Severe tricuspid regurgitation (TR), diagnosed with echocardiography, is not necessarily symptomatic. The study aim was to identify echocardiographic markers associated with right-sided congestive heart failure (RCHF) in patients with severe TR.
Ninety-six patients (30 males, 66 females; mean age 67 +/- 11 years) with echocardiographic findings of severe TR were followed clinically and with transthoracic echocardiography (TTE). Clinical data were collected on heavy diuretic consumption and signs of volume overload (neck vein congestion, lower-limb edema, ascites). TTE included evaluation of the right heart chamber dimensions, systolic function, pulmonary pressure and change in inferior vena cava (IVC) diameter during respiration. Patients were subdivided according to the presence (group A, n = 52) or absence (group B, n = 44) of signs of RCHF that included volume overload and heavy diuretic consumption (i.e. > or = 80 mg furosemide/day or combined furosemide/spironolactone at any dosage).
Among the patients, 52 (54.2%) had RCHF and 44 (45.8%) did not. Atrial fibrillation was present in 88% of group A and 76% of group B (p = NS). Group A patients had a significantly larger right ventricular area, right atrial area and IVC diameter than group B patients, but a significantly smaller variation in IVC diameter during respiration (11.2 +/- 8.5% versus 24.3 +/- 14.1%, p = 0.001). Right ventricular systolic function and systolic pulmonary pressure were similar in the two groups. On multivariate analysis, respiratory-related variation in IVC diameter (p <0.001) and systolic pulmonary artery pressure (p = 0.04) were the only independent echocardiographic markers of RCHE CONCLUSION: Diminished respiratory variation in IVC diameter and systolic pulmonary artery pressure are independent markers of volume overload in patients with severe TR. These findings may reflect exhaustion of IVC capacitance due to markedly increased right heart filling pressures, though intrinsic changes in IVC tonus may also be involved.
经超声心动图诊断的重度三尖瓣反流（TR）不一定有症状。本研究的目的是确定重度TR患者中与右侧充血性心力衰竭（RCHF）相关的超声心动图标志物。
对96例经超声心动图检查发现重度TR的患者（30例男性，66例女性；平均年龄67±11岁）进行临床随访及经胸超声心动图（TTE）检查。收集关于大量使用利尿剂及容量超负荷体征（颈静脉充血、下肢水肿、腹水）的临床数据。TTE包括评估右心腔大小、收缩功能、肺动脉压力以及呼吸过程中下腔静脉（IVC）直径的变化。根据是否存在RCHF体征（包括容量超负荷和大量使用利尿剂，即呋塞米≥80mg/天或任何剂量的呋塞米/螺内酯联合用药）将患者分为两组，存在RCHF体征的为A组（n = 52），不存在的为B组（n = 44）。
患者中，52例（54.2%）有RCHF，44例（45.8%）没有。A组88%的患者和B组76%的患者存在心房颤动（p = 无显著性差异）。A组患者的右心室面积、右心房面积和IVC直径显著大于B组患者，但呼吸过程中IVC直径的变化显著更小（11.2±8.5%对24.3±14.1%，p = 0.001）。两组的右心室收缩功能和收缩期肺动脉压力相似。多因素分析显示，呼吸相关的IVC直径变化（p <0.001）和收缩期肺动脉压力（p = 0.04）是RCHF唯一的独立超声心动图标志物。结论：IVC直径和收缩期肺动脉压力的呼吸变化减小是重度TR患者容量超负荷的独立标志物。这些发现可能反映了由于右心充盈压明显升高导致IVC容量耗竭，尽管IVC张力的内在变化也可能参与其中。
