Value of proximal regurgitant jet size in tricuspid regurgitation

Abstract

Recent studies have shown good agreement between proximal regurgitant jet size obtained with transthoracic color flow mapping and regurgitant fraction in patients with mitral regurgitation. To evaluate this in patients with tricuspid regurgitation, we analyzed 40 patients in sinus rhythm, 16 with free jets and 24 with impinging jets, comparing proximal jet size (millimeters) with parameters derived from the Doppler two-dimensional echocardiographic method (regurgitant fraction) and the flow-convergence method (peak flow rate, effective regurgitant orifice area, and momentum). Good agreement was noted between peak flow rate ( r = 0.80, p < 0.001), momentum ( r = 0.80, p < 0.001), and effective regurgitant orifice area ( r = 0.78, p < 0.001), with proximal jet size measured in the apical four-chamber view in patients with free jets. The average of jet proximal size in three planes also had good correlation with peak flow rate ( r = 0.75, p < 0.001), regurgitant fraction, momentum, and effective regurgitant orifice area ( r = 0.74, p < 0.001). In patients with impinging jets, agreement was fair between effective regurgitant orifice ( r = 0.65, p < 0.001), peak flow rate (0.65, p < 0.001), and momentum ( r = 0.62, p < 0.001) with mean jet proximal size. Jet proximal size obtained with transthoracic color flow mapping is a good semiquantitative tool for measuring tricuspid regurgitation in free jets that correlates well with established measures of the severity and with new parameters available from analysis of the proximal acceleration field. In patients with eccentrically directed wall jets, the correlation weakens but still appears clinically significant.