Tricuspid regurgitation classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tricuspid regurgitation}} | {{Tricuspid regurgitation}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Rim}} {{FB}} | ||
==Overview== | ==Overview== | ||
Tricuspid regurgitation (TR) can be classified | [[Tricuspid regurgitation]] (TR) can be broadly classified as primary or secondary. Primary (or organic) TR results from an organic lesion of the [[tricuspid valve]] itself, whereas secondary (or functional) TR is caused by [[left heart failure]] or [[pulmonary hypertension]] without an intrinsic abnormality of the [[tricuspid valve]]. | ||
==Classification== | ==Classification== | ||
'''2014 AHA/ACC Guidelines for | |||
* The stages of TR can be estimated based on specific criteria for the [[valve]] [[anatomy]], valve [[hemodynamics]], associated [[cardiac]] findings, and [[symptoms]]. | |||
'''2014 AHA/ACC Guidelines for Valvular Heart Diseases'''<ref name="pmid24589852">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= | issue= | pages= | pmid=24589852 | doi=10.1161/CIR.0000000000000029 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24589852 }} </ref><ref name="pmid28298458">{{cite journal |vauthors=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A |title=2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines |journal=Circulation |volume=135 |issue=25 |pages=e1159–e1195 |date=June 2017 |pmid=28298458 |doi=10.1161/CIR.0000000000000503 |url=}}</ref><ref name="pmid8034882">{{cite journal| author=Sagie A, Schwammenthal E, Padial LR, Vazquez de Prada JA, Weyman AE, Levine RA| title=Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients. | journal=J Am Coll Cardiol | year= 1994 | volume= 24 | issue= 2 | pages= 446-53 | pmid=8034882 | doi=10.1016/0735-1097(94)90302-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8034882 }}</ref><ref name="pmid22109981">{{cite journal| author=Spinner EM, Lerakis S, Higginson J, Pernetz M, Howell S, Veledar E | display-authors=etal| title=Correlates of tricuspid regurgitation as determined by 3D echocardiography: pulmonary arterial pressure, ventricle geometry, annular dilatation, and papillary muscle displacement. | journal=Circ Cardiovasc Imaging | year= 2012 | volume= 5 | issue= 1 | pages= 43-50 | pmid=22109981 | doi=10.1161/CIRCIMAGING.111.965707 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22109981 }}</ref><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><ref name="pmid20956397">{{cite journal| author=Irwin RB, Luckie M, Khattar RS| title=Tricuspid regurgitation: contemporary management of a neglected valvular lesion. | journal=Postgrad Med J | year= 2010 | volume= 86 | issue= 1021 | pages= 648-55 | pmid=20956397 | doi=10.1136/pgmj.2009.090886 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956397 }}</ref> | |||
<span style="font-size:85%">'''Abbreviations:''' '''CW:''' continuous wave; '''ICD:''' [[implantable cardioverter-defibrillator]]; '''IE:''' [[infective endocarditis]]; '''IVC:''' [[inferior vena cava]]; '''RA:''' [[right atrium]]; '''RV:''' [[right ventricle]]; '''TR:''' [[tricuspid regurgitation]]</span> | <span style="font-size:85%">'''Abbreviations:''' '''CW:''' continuous wave; '''ICD:''' [[implantable cardioverter-defibrillator]]; '''IE:''' [[infective endocarditis]]; '''IVC:''' [[inferior vena cava]]; '''RA:''' [[right atrium]]; '''RV:''' [[right ventricle]]; '''TR:''' [[tricuspid regurgitation]]</span> | ||
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|- | |- | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Stage | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Definition | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Valve anatomy | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Valve hemodynamics | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Hemodynamic consequences | ||
!style="padding: 0 5px; font-size: 100%; | !style="padding: 0 5px; font-size: 100%; align=center | Symptoms of TR, left heart failure, or pulmonary vascular disease | ||
|- | |- | ||
| A || At risk of TR || ''Primary''<br> | | A || At risk of TR || ''Primary''<br> | ||
* Mild [[rheumatic]] change | * Mild [[rheumatic]] change | ||
* Mild prolapse | * Mild [[prolapse]] | ||
* Findings related to other conditions ([[IE]], [[carcinoid]], [[radiation]]) | * Findings related to other conditions ([[IE]], [[carcinoid]], [[radiation]]) | ||
* Presence of an intra-annular RV [[pacemaker]] or [[ICD]] lead | * Presence of an intra-annular RV [[pacemaker]] or [[ICD]] lead | ||
* Cardiac [[transplant]] (biopsy related) | * Cardiac [[transplant]] ([[biopsy]]-related) | ||
''Secondary'' <br> | ''Secondary'' <br> | ||
* No abnormal findings | * No abnormal findings | ||
| Line 36: | Line 38: | ||
| B || Progressive TR|| ''Primary'' | | B || Progressive TR|| ''Primary'' | ||
* Progressive leaflet deterioration/destruction | * Progressive leaflet deterioration/destruction | ||
* Moderate-to-severe prolapse and limited chordal rupture | * Moderate-to-severe [[prolapse]] and limited chordal rupture | ||
''Secondary'' | ''Secondary'' | ||
* Beginning of annular dilation | * Beginning of annular dilation | ||
* Moderate leaflet tethering | * Moderate leaflet tethering | ||
| Mild TR | | Mild TR | ||
* Central jet area <5.0 cm<sup>2</sup> | * Central jet area <5.0 cm<sup>2</sup> | ||
* Undefined width of vena contracta | * Undefined width of vena contracta | ||
| Line 49: | Line 52: | ||
* Undefined width of vena contracta width but <0.70 cm | * Undefined width of vena contracta width but <0.70 cm | ||
* Dense, variable CW jet density and contour | * Dense, variable CW jet density and contour | ||
* [[Systolic]] blunting of hepatic vein flow | * [[Systolic]] blunting of [[hepatic vein]] flow | ||
| Mild TR | | Mild TR | ||
* Normal size of RV/RA/IVC | * Normal size of RV/RA/IVC | ||
| Line 67: | Line 70: | ||
<sup>2</sup>* Vena contracta width >0.7 cm | <sup>2</sup>* Vena contracta width >0.7 cm | ||
* Dense, triangular CW jet density and contour with early peak | * Dense, triangular CW jet density and contour with early peak | ||
* [[Systolic]] reversal in hepatic vein flow | * [[Systolic]] reversal in [[hepatic vein]] flow | ||
|* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation | |* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation | ||
* Increased RA pressure with “c-V” wave | * Increased RA pressure with “c-V” wave | ||
| Line 81: | Line 84: | ||
* Vena contracta width >0.7 cm | * Vena contracta width >0.7 cm | ||
* Dense, triangular CW jet density and contour with early peak | * Dense, triangular CW jet density and contour with early peak | ||
* Systolic reversal in hepatic vein flow | * Systolic reversal in [[hepatic vein]] flow | ||
|* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation | |* Dilated RV/RA/IVC and decreased [[IVC]] respirophasic variation | ||
* Increased RA pressure with “c-V” wave | * Increased RA pressure with “c-V” wave | ||
* Possible diastolic interventricular septal flattening | * Possible diastolic [[Interventricular septum|interventricular]] septal flattening | ||
| Presence of symptoms ([[fatigue]], [[dyspnea]], [[anorexia]], [[edema]], [[abdominal distention]], [[palpitations]]) | | Presence of symptoms ([[fatigue]], [[dyspnea]], [[anorexia]], [[edema]], [[abdominal distention]], [[palpitations]]) | ||
|- | |- | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 13:54, 21 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2] Fatimo Biobaku M.B.B.S [3]
Overview
Tricuspid regurgitation (TR) can be broadly classified as primary or secondary. Primary (or organic) TR results from an organic lesion of the tricuspid valve itself, whereas secondary (or functional) TR is caused by left heart failure or pulmonary hypertension without an intrinsic abnormality of the tricuspid valve.
Classification
- The stages of TR can be estimated based on specific criteria for the valve anatomy, valve hemodynamics, associated cardiac findings, and symptoms.
2014 AHA/ACC Guidelines for Valvular Heart Diseases[1][2][3][4][5][6]
Abbreviations: CW: continuous wave; ICD: implantable cardioverter-defibrillator; IE: infective endocarditis; IVC: inferior vena cava; RA: right atrium; RV: right ventricle; TR: tricuspid regurgitation
| Stage | Definition | Valve anatomy | Valve hemodynamics | Hemodynamic consequences | Symptoms of TR, left heart failure, or pulmonary vascular disease |
|---|---|---|---|---|---|
| A | At risk of TR | Primary
Secondary
|
Absent or trace TR | Absent | Absent |
| B | Progressive TR | Primary
Secondary
|
Mild TR
Moderate TR
|
Mild TR
Moderate TR |
Absent |
| C | Asymptomatic severe TR | Primary
Secondary
|
* Central jet area >10.0 cm
2* Vena contracta width >0.7 cm
|
* Dilated RV/RA/IVC and decreased IVC respirophasic variation
|
Absent |
| D | Symptomatic severe TR | Primary
Secondary
|
* Central jet area >10.0 cm2
|
* Dilated RV/RA/IVC and decreased IVC respirophasic variation
|
Presence of symptoms (fatigue, dyspnea, anorexia, edema, abdominal distention, palpitations) |
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A (June 2017). "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 135 (25): e1159–e1195. doi:10.1161/CIR.0000000000000503. PMID 28298458.
- ↑ Sagie A, Schwammenthal E, Padial LR, Vazquez de Prada JA, Weyman AE, Levine RA (1994). "Determinants of functional tricuspid regurgitation in incomplete tricuspid valve closure: Doppler color flow study of 109 patients". J Am Coll Cardiol. 24 (2): 446–53. doi:10.1016/0735-1097(94)90302-6. PMID 8034882.
- ↑ Spinner EM, Lerakis S, Higginson J, Pernetz M, Howell S, Veledar E; et al. (2012). "Correlates of tricuspid regurgitation as determined by 3D echocardiography: pulmonary arterial pressure, ventricle geometry, annular dilatation, and papillary muscle displacement". Circ Cardiovasc Imaging. 5 (1): 43–50. doi:10.1161/CIRCIMAGING.111.965707. PMID 22109981.
- ↑ 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.
- ↑ Irwin RB, Luckie M, Khattar RS (2010). "Tricuspid regurgitation: contemporary management of a neglected valvular lesion". Postgrad Med J. 86 (1021): 648–55. doi:10.1136/pgmj.2009.090886. PMID 20956397.