Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Cardiovascular Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Am Soc Echocardiogr. 2021 Jan;34(1):30-37. doi: 10.1016/j.echo.2020.09.003. Epub 2020 Oct 16.
Characteristics of tricuspid valve prolapse (TVP) on transthoracic echocardiography are not well defined. As tricuspid valve interventions are increasingly considered, information on the definition and clinical significance of TVP is needed.
At the authors' institution, between January 26, 2000, and September 20, 2018, 410 patients (0.3%) were determined to have suspected TVP. These transthoracic echocardiograms and those of 97 age- and sex-matched normal control subjects were reviewed. Interrater agreement on TVP by visual inspection was assessed in a blinded subset. Leaflet atrial displacement (AD) > 2 SDs above the mean in normal control subjects was used to identify an empiric definition of TVP Features of patients meeting this definition were evaluated.
Three hundred twelve transthoracic echocardiograms with available and interpretable images (76.1%) were included. Interrater agreement on TVP diagnosis by visual inspection was moderate. Normal values of AD were up to 4 mm in the right ventricular inflow view and 2 mm in all other views. AD > 2 mm in the parasternal short-axis view had the best accuracy against suspected TVP to identify TVP. Those with TVP by this definition more frequently had 3 to 4+ tricuspid regurgitation (22.2% vs 3.1%; P < .001), mitral valve prolapse (MVP; 75.0% vs 3.1%; P < .001), and more clinically significant MVP (greater prevalence of 3 to 4+ mitral regurgitation). No difference in mortality was observed in those with isolated TVP versus TVP and MVP (log-rank P = .93).
In the largest study of TVP to date, interrater agreement on TVP diagnosis by visual inspection was moderate. A cutoff of >2-mm AD in the parasternal short-axis view was optimal to define TVP. Those with TVP by this definition had more significant tricuspid regurgitation, larger right ventricles, and more clinically significant MVP. Overall, these results suggest an increased role for surveillance for TVP and the need for clear diagnostic criteria in updated guidelines.
经胸超声心动图(transthoracic echocardiography, TTE) 对三尖瓣脱垂(tricuspid valve prolapse, TVP)的特征定义并不明确。由于三尖瓣介入治疗的应用日益增多，因此需要了解 TVP 的定义和临床意义。
在作者所在机构，2000 年 1 月 26 日至 2018 年 9 月 20 日期间，有 410 例患者（0.3%）被诊断为疑似 TVP。回顾了这些 TTE 检查结果以及 97 例年龄和性别匹配的正常对照者的 TTE 检查结果。在盲法亚组中评估了 TVP 通过视觉检查的诊断的组内一致性。使用正常对照组中瓣叶心房移位(leaflet atrial displacement, AD)超过均值 2 个标准差来确定 TVP 的经验定义，并评估符合该定义的患者的特征。
有 312 例 TTE 检查结果有可供解释的图像（76.1%），包括在内。TVP 诊断的视觉检查组内一致性为中度。在右心室流入道视图中，AD 的正常范围高达 4mm，而在所有其他视图中，AD 的正常范围为 2mm。胸骨旁短轴视图中 AD > 2mm 对诊断疑似 TVP 以识别 TVP 的准确性最高。通过该定义诊断为 TVP 的患者，三尖瓣反流 3 至 4+级（22.2% vs. 3.1%；P<.001）、二尖瓣脱垂（mitral valve prolapse, MVP；75.0% vs. 3.1%；P<.001）和更具临床意义的 MVP（更常见的 3 至 4+级二尖瓣反流）更为常见。孤立性 TVP 与 TVP 和 MVP 患者之间的死亡率无差异（对数秩检验 P=.93）。
在迄今为止 TVP 的最大研究中，通过视觉检查诊断 TVP 的组内一致性为中度。胸骨旁短轴视图中 AD > 2mm 是定义 TVP 的最佳截断值。通过该定义诊断为 TVP 的患者三尖瓣反流更严重、右心室更大，且 MVP 更具临床意义。总体而言，这些结果表明 TVP 的监测作用增强，且需要在更新的指南中明确诊断标准。
