Tricuspid regurgitation diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Tricuspid regurgitation}}
{{Tricuspid regurgitation}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{VKG}}
== Overview ==
== Overview ==
Tricuspid regurgitation is primarily diagnosed based on the findings in echocardiography. In tricuspid regurgitation patients echocardiography helps in evaluation of severity of the tricuspid regurgitation. Cardiovascular magnetic resonance (CMR) is helpful in estimation of right ventricular  size and systolic function. Pulmonary artery hypertension can be evaluated by doing cardiac catheterization. ECG in the patients of TS helpful when the TR is severe.
[[Tricuspid regurgitation]] is primarily diagnosed based on the findings in [[echocardiography]]. In [[tricuspid regurgitation]] patients [[echocardiography]] helps in evaluation of severity of the [[tricuspid regurgitation]]. [[Cardiovascular magnetic resonance imaging (CMR)|Cardiovascular magnetic resonance]] ([[CMR]]) is helpful in estimation of [[Right ventricle|right ventricular]] size and [[systolic]] function. [[Pulmonary artery hypertension]] can be evaluated by doing [[cardiac catheterization]]. [[The electrocardiogram|ECG]] in the patients of TS helpful when the TR is severe.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
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=== Study of choice ===
=== Study of choice ===


* The diagnostic study of choice for tricuspid regurgitation is echocardiography.
* The diagnostic study of choice for [[tricuspid regurgitation]] is [[echocardiography]].<ref name="pmid26503944">{{cite journal| author=Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ| title=Secondary tricuspid valve regurgitation: a forgotten entity. | journal=Heart | year= 2015 | volume= 101 | issue= 22 | pages= 1840-8 | pmid=26503944 | doi=10.1136/heartjnl-2014-307252 | pmc=4680164 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26503944  }}</ref>
* Color flow Doppler echocardiography is the best to evaluate tricuspid regurgitation.
* Color flow [[doppler echocardiography]] is the best to evaluate [[tricuspid regurgitation]].
* The following are findings in tricuspid regurgitation on echocardiography:
* The following are findings in [[tricuspid regurgitation]] on [[echocardiography]]:<ref name="pmid23993694">{{cite journal| author=Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV| title=Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures. | journal=J Am Soc Echocardiogr | year= 2013 | volume= 26 | issue= 10 | pages= 1143-1152 | pmid=23993694 | doi=10.1016/j.echo.2013.07.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23993694  }}</ref><ref name="pmid23860094">{{cite journal| author=de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ | display-authors=etal| title=Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification. | journal=J Am Soc Echocardiogr | year= 2013 | volume= 26 | issue= 9 | pages= 1063-72 | pmid=23860094 | doi=10.1016/j.echo.2013.06.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23860094  }}</ref><ref name="ZoghbiAdams2017">{{cite journal|last1=Zoghbi|first1=William A.|last2=Adams|first2=David|last3=Bonow|first3=Robert O.|last4=Enriquez-Sarano|first4=Maurice|last5=Foster|first5=Elyse|last6=Grayburn|first6=Paul A.|last7=Hahn|first7=Rebecca T.|last8=Han|first8=Yuchi|last9=Hung|first9=Judy|last10=Lang|first10=Roberto M.|last11=Little|first11=Stephen H.|last12=Shah|first12=Dipan J.|last13=Shernan|first13=Stanton|last14=Thavendiranathan|first14=Paaladinesh|last15=Thomas|first15=James D.|last16=Weissman|first16=Neil J.|title=Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation|journal=Journal of the American Society of Echocardiography|volume=30|issue=4|year=2017|pages=303–371|issn=08947317|doi=10.1016/j.echo.2017.01.007}}</ref><ref name="pmid5494426">{{cite journal| author=Iurovskaia VP| title=[Polycystic ovaries]. | journal=Akush Ginekol (Mosk) | year= 1970 | volume= 46 | issue= 8 | pages= 63-6 | pmid=5494426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5494426  }}</ref><ref name="HahnThomas2019">{{cite journal|last1=Hahn|first1=Rebecca T.|last2=Thomas|first2=James D.|last3=Khalique|first3=Omar K.|last4=Cavalcante|first4=João L.|last5=Praz|first5=Fabien|last6=Zoghbi|first6=William A.|title=Imaging Assessment of Tricuspid Regurgitation Severity|journal=JACC: Cardiovascular Imaging|volume=12|issue=3|year=2019|pages=469–490|issn=1936878X|doi=10.1016/j.jcmg.2018.07.033}}</ref><ref name="pmid26758273">{{cite journal| author=Hudzik B, Poloński L, Gąsior M| title=Lancisi sign: giant C-V waves of tricuspid regurgitation. | journal=Intern Emerg Med | year= 2016 | volume= 11 | issue= 8 | pages= 1139-1140 | pmid=26758273 | doi=10.1007/s11739-015-1384-4 | pmc=5114320 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26758273  }}</ref>
**Tricuspid valve motion which may be normal to high based on the severity of the presentation.
**[[Tricuspid valve]] motion which may be normal to high based on the severity of the presentation.
**Characteristic primary valvular abnormalities can be detected by tricuspid valve motion which includes the conditions like:
**Characteristic primary [[Valvular Diseases|valvular]] abnormalities can be detected by [[tricuspid valve]] motion which includes the conditions like:<ref name="Adler2017">{{cite journal|last1=Adler|first1=Dale S.|title=Non-functional tricuspid valve disease|journal=Annals of Cardiothoracic Surgery|volume=6|issue=3|year=2017|pages=204–213|issn=2225319X|doi=10.21037/acs.2017.04.04}}</ref><ref name="ParanonAcar2008">{{cite journal|last1=Paranon|first1=S.|last2=Acar|first2=P.|title=Ebstein's anomaly of the tricuspid valve: from fetus to adult|journal=Heart|volume=94|issue=2|year=2008|pages=237–243|issn=1355-6037|doi=10.1136/hrt.2006.105262}}</ref>
***Ebstein's anomaly
***[[Ebstein's anomaly]]
***Carcinoid heart disease
***[[Carcinoid Disease|Carcinoid]] heart disease
***Rheumatic valve disease
***[[Rheumatic Heart Disease|Rheumatic]] valve disease
***Leaflet prolapse
***[[Tricuspid valve prolapse]]
***Flail leaflet
***Flail leaflet
***Endocarditis
***[[Endocarditis]]
**Right ventricle and right atrium dilation
**[[Right ventricle]] and [[right atrium]] dilation
**By using the vena contracta method with colour doppler we can estimate the severity of the tricuspid regurgitation and that includes:  
**By using the [[vena contracta]] method with colour doppler we can estimate the severity of the [[tricuspid regurgitation]] and that includes:  
***The vena contracta width has to be more than 0.7 cm along with systolic flow reversal in the hepatic veins
***The [[vena contracta]] width has to be more than 0.7 cm along with systolic flow reversal in the hepatic veins
***In the presence of atrial fibrillation, systolic flow reversal in the hepatic veins cannot be accurate <br />
***In the presence of atrial fibrillation, systolic flow reversal in the hepatic veins cannot be accurate
****  
**Dilation tricuspid annulus
**Paradoxical movement may noticed in interventricular septum
**Right ventricle function can be analysed
**By using the modified Bernoulli equation, we can estimate the pulmonary hypertension on echocardiography by measuring the right ventricle to right atrial systolic gradient from the velocity of the tricuspid regurgitation jet


OR
[[File:Lancisi sign.jpg|center|thumb|706x706px|Giant systolic pulsations with prominent V-waves, known as the Lancisi sign or C-V waves; B transthoracic echocardiography 4-chamber view demonstrating a dilated right atrium and right ventricle and severe tricuspid regurgitation with a moderately reduced right ventricular function (RA right atrium, RV right ventricle, TR tricuspid regurgitation, LA felt atrium, LV left ventricle). Case courtesy by Bartosz Hudzik et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114320/|title=Lancisi sign: giant C-V waves of tricuspid regurgitation, transthoracic echocardiography 4-chamber view demonstrating a dilated right atrium and right ventricle and severe tricuspid regurgitation with a moderately reduced right ventricular function (RA right atrium, RV right ventricle, TR tricuspid regurgitation, LA felt atrium, LV left ventricle)|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
 
[[File:Severe tricuspid regurgitation.jpg|alt=Color-flow Doppler showing severe tricuspid regurgitation.|center|thumb|473x473px|Color-flow Doppler showing severe tricuspid regurgitation. Case courtesy by Sungwon Na et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693829/|title=Traumatic Tricuspid Regurgitation Following Cardiac Massage|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
The following result of [gold standard test] is confirmatory of [disease name]:
<br />
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for tricuspid regurgitation is echocardiography.
 
There is no single diagnostic study of choice for the diagnosis of [disease name].  
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==
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[[Category: Cardiology]]

Latest revision as of 16:25, 20 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Tricuspid regurgitation is primarily diagnosed based on the findings in echocardiography. In tricuspid regurgitation patients echocardiography helps in evaluation of severity of the tricuspid regurgitation. Cardiovascular magnetic resonance (CMR) is helpful in estimation of right ventricular size and systolic function. Pulmonary artery hypertension can be evaluated by doing cardiac catheterization. ECG in the patients of TS helpful when the TR is severe.

Diagnostic Study of Choice

Study of choice

Giant systolic pulsations with prominent V-waves, known as the Lancisi sign or C-V waves; B transthoracic echocardiography 4-chamber view demonstrating a dilated right atrium and right ventricle and severe tricuspid regurgitation with a moderately reduced right ventricular function (RA right atrium, RV right ventricle, TR tricuspid regurgitation, LA felt atrium, LV left ventricle). Case courtesy by Bartosz Hudzik et al[10]
Color-flow Doppler showing severe tricuspid regurgitation.
Color-flow Doppler showing severe tricuspid regurgitation. Case courtesy by Sungwon Na et al[11]


References

  1. ↑ Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ (2015). "Secondary tricuspid valve regurgitation: a forgotten entity". Heart. 101 (22): 1840–8. doi:10.1136/heartjnl-2014-307252. PMC 4680164. PMID 26503944.
  2. ↑ Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV (2013). "Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures". J Am Soc Echocardiogr. 26 (10): 1143–1152. doi:10.1016/j.echo.2013.07.020. PMID 23993694.
  3. ↑ de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ; et al. (2013). "Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification". J Am Soc Echocardiogr. 26 (9): 1063–72. doi:10.1016/j.echo.2013.06.006. PMID 23860094.
  4. ↑ Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
  5. ↑ Iurovskaia VP (1970). "[Polycystic ovaries]". Akush Ginekol (Mosk). 46 (8): 63–6. PMID 5494426.
  6. ↑ Hahn, Rebecca T.; Thomas, James D.; Khalique, Omar K.; Cavalcante, João L.; Praz, Fabien; Zoghbi, William A. (2019). "Imaging Assessment of Tricuspid Regurgitation Severity". JACC: Cardiovascular Imaging. 12 (3): 469–490. doi:10.1016/j.jcmg.2018.07.033. ISSN 1936-878X.
  7. ↑ Hudzik B, Poloński L, Gąsior M (2016). "Lancisi sign: giant C-V waves of tricuspid regurgitation". Intern Emerg Med. 11 (8): 1139–1140. doi:10.1007/s11739-015-1384-4. PMC 5114320. PMID 26758273.
  8. ↑ Adler, Dale S. (2017). "Non-functional tricuspid valve disease". Annals of Cardiothoracic Surgery. 6 (3): 204–213. doi:10.21037/acs.2017.04.04. ISSN 2225-319X.
  9. ↑ Paranon, S.; Acar, P. (2008). "Ebstein's anomaly of the tricuspid valve: from fetus to adult". Heart. 94 (2): 237–243. doi:10.1136/hrt.2006.105262. ISSN 1355-6037.
  10. ↑ "Lancisi sign: giant C-V waves of tricuspid regurgitation, transthoracic echocardiography 4-chamber view demonstrating a dilated right atrium and right ventricle and severe tricuspid regurgitation with a moderately reduced right ventricular function (RA right atrium, RV right ventricle, TR tricuspid regurgitation, LA felt atrium, LV left ventricle)".
  11. ↑ "Traumatic Tricuspid Regurgitation Following Cardiac Massage".

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