Echocardiography Laboratory and Heart Valves Clinic, Department of Cardiology, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, P.O. Box 9602, Haifa 31096, Israel.
Eur Heart J Cardiovasc Imaging. 2013 Oct;14(10):957-62. doi: 10.1093/ehjci/jet019. Epub 2013 Feb 6.
Respiratory changes in tricuspid regurgitation (TR) systolic velocities are occasionally demonstrated by Doppler echocardiography in patients with TR. We tested the hypothesis that excessive respiratory changes in TR velocities are diagnostic of severe TR.
The difference between the maximal (expiratory) and minimal (inspiratory) TR systolic velocities during spontaneous respiration was measured by Doppler echocardiography in 68 patients with severe TR and 68 patients with moderate TR. The diagnostic value of the respiratory changes in TR velocity for detecting severe TR was assessed. The respiratory differences in TR velocities were greater in patients with severe TR (0.72 ± 0.30 m/s), compared with patients with moderate TR (0.28 ± 0.18; P < 0.001). Using receiver-operating characteristics analysis, the area under the curve for the respiratory difference in TR velocities for diagnosing severe TR was 0.92 (95% confidence interval: 0.87-0.96; P < 0.001). A difference in TR velocity ≥0.6 m/s had a sensitivity of 66%, specificity of 94%, positive predictive value of 92%, and a negative predictive value of 74% for diagnosing severe TR. Among patients with severe TR, excessive values of TR velocity difference were associated with signs of more severe TR (greater right ventricular size and malcoaptation of the tricuspid valve leaflets).
Excessive respiratory changes in Doppler measurements of TR systolic velocities are a specific sign of severe TR.
在三尖瓣反流（TR）患者中，多普勒超声心动图偶尔会显示 TR 收缩期速度的呼吸变化。我们检验了一个假设，即 TR 速度的呼吸变化过度是重度 TR 的诊断指标。
通过多普勒超声心动图测量 68 例重度 TR 和 68 例中度 TR 患者在自主呼吸时最大（呼气）和最小（吸气）TR 收缩期速度之间的差异。评估 TR 速度呼吸变化对检测重度 TR 的诊断价值。与中度 TR 患者（0.28 ± 0.18；P < 0.001）相比，重度 TR 患者的 TR 速度呼吸差异更大（0.72 ± 0.30 m/s）。使用受试者工作特征曲线分析，TR 速度呼吸差异诊断重度 TR 的曲线下面积为 0.92（95%置信区间：0.87-0.96；P < 0.001）。TR 速度差异≥0.6 m/s 对诊断重度 TR 的灵敏度为 66%，特异性为 94%，阳性预测值为 92%，阴性预测值为 74%。在重度 TR 患者中，TR 速度差异值过大与 TR 更严重的迹象（右心室增大和三尖瓣瓣叶对合不良）相关。
多普勒测量 TR 收缩期速度的呼吸变化过度是重度 TR 的特异性表现。
