Nemes Attila, Rácz Gergely, Kormányos Árpád, Ruzsa Zoltán, Achim Alexandru, Lengyel Csaba
Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary.
Life (Basel). 2023 Oct 18;13(10):2079. doi: 10.3390/life13102079.
The tricuspid valve is an atrioventricular valve located on the right side of the heart, which consists of the fibrous tricuspid annulus (TA), three valvular leaflets and a supporting apparatus, the papillary muscles and the tendinous chords. The TA is an oval-shaped three-dimensional (3D) fibrous structure with a complex spatial movement during the cardiac cycle. Three-dimensional echocardiography (3DE) could help during "en-face" assessment of TA dimensions and related functional properties featuring its "sphincter-like" function. TA plane systolic excursion (TAPSE) is a displacement of the lateral edge of the TA toward the apex in systole measured in apical long-axis using M-mode echocardiography (MME). The aim of this study was to determine potential relationships between TA size and its "sphincter-like" and "longitudinal" functions in healthy adults with no functional tricuspid regurgitation.
The present study consisted of 119 healthy patients (age: 34.6 ± 11.5 years, 70 men) who underwent routine echocardiography with M-mode-derived TAPSE measurement and 3DE. Two subgroups of healthy subjects were compared with each other. A total of 29 subjects with TAPSE between 17 and 21 mm were compared with 90 cases with TAPSE ≥ 22 mm.
Subjects with TAPSE of 17-21 mm had tendentiously dilated TA dimensions compared with subjects with TAPSE ≥ 22 mm. Significant differences could be detected in the end-systolic TA area (5.85 ± 1.90 cm vs. 3.70 ± 1.22 cm, < 0.05), leading to impaired TAFAC (24.8 ± 9.0% vs. 35.1 ± 9.1%, < 0.05) in subjects with lower TAPSE (17-21 mm) compared with subjects with TAPSE ≥ 22 mm. TAPSE did not show correlations with any TA size or "sphincter-like" functional parameters as determined using 3DE.
Three-dimensional echocardiography is capable of measuring TA dimensions and functional "sphincter-like" properties, which are associated with MME-derived TAPSE, suggesting a sensitive and harmonic TA function in healthy adults without functional tricuspid regurgitation.
三尖瓣是位于心脏右侧的房室瓣，由纤维性三尖瓣环（TA）、三个瓣膜小叶和一个支撑装置（乳头肌和腱索）组成。TA是一个椭圆形的三维（3D）纤维结构，在心动周期中具有复杂的空间运动。三维超声心动图（3DE）有助于在“正面”评估TA尺寸及其具有“括约肌样”功能的相关功能特性。TA平面收缩期偏移（TAPSE）是指在心底长轴切面使用M型超声心动图（MME）测量的收缩期TA外侧边缘向心尖的位移。本研究的目的是确定在无功能性三尖瓣反流的健康成年人中TA大小与其“括约肌样”和“纵向”功能之间的潜在关系。
本研究纳入了119例健康患者（年龄：34.6±11.5岁，男性70例），这些患者接受了常规超声心动图检查，包括测量M型超声心动图衍生的TAPSE和3DE。将健康受试者分为两个亚组并进行比较。将29例TAPSE在17至21mm之间的受试者与90例TAPSE≥22mm的受试者进行比较。
与TAPSE≥22mm的受试者相比，TAPSE为17至21mm的受试者TA尺寸有明显扩张。在收缩末期TA面积方面可检测到显著差异（5.85±1.90cm²对3.70±1.22cm²，P<0.05），导致TAPSE较低（17至21mm）的受试者与TAPSE≥22mm的受试者相比TA功能面积系数受损（24.8±9.0%对35.1±9.1%，P<0.05）。TAPSE与使用3DE确定的任何TA大小或“括约肌样”功能参数均无相关性。
三维超声心动图能够测量TA尺寸和功能性“括约肌样”特性，这些特性与MME衍生的TAPSE相关，提示在无功能性三尖瓣反流的健康成年人中TA功能敏感且协调。
