Tricuspid regurgitation stages: Difference between revisions
Rim Halaby (talk | contribs) (→Stages) |
No edit summary |
||
(14 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{CMG}}; {{AE}} {{Rim}} | ||
{{Tricuspid regurgitation}} | {{Tricuspid regurgitation}} | ||
==Overview== | ==Overview== | ||
The stage of tricuspid regurgitation (TR) can be estimated based on specific criteria for the valve anatomy, valve hemodynamics, associated cardiac findings, and symptoms. The stages of TR are the following: at risk of TR, progressive TR, asymptomatic severe TR, and symptomatic severe TR.<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> | |||
==Stages== | ==Stages== | ||
{| | |||
| ''' | == 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines<ref name="pmid33332150">{{cite journal| author=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F | display-authors=etal| title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 143 | issue= 5 | pages= e72-e227 | pmid=33332150 | doi=10.1161/CIR.0000000000000923 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33332150 }}</ref> == | ||
=== Stages of TR === | |||
{| class="wikitable" | |||
|- | |||
! style="padding: 0 5px; font-size: 100%; align=center " | Stage | |||
! style="padding: 0 5px; font-size: 100%; align=center " | Definition | |||
! style="padding: 0 5px; font-size: 100%; align=center " | Valve hemodynamics | |||
! style="padding: 0 5px; font-size: 100%; align=center " | Hemodynamic consequences | |||
! style="padding: 0 5px; font-size: 100%; align=center " | Clinical Symptoms and Presentation | |||
|- | |||
| B || Progressive TR | |||
| | |||
* Central jet <50% RA | |||
* Vena contracta width <0.7 cm | |||
* ERO <0.40 cm2 | |||
* Regurgitant volume <45 mL | |||
|None | |||
| None | |||
|- | |||
| C || Asymptomatic severe TR | |||
| | |||
* Central jet ≥50% RA | |||
* Vena contracta width ≥0.7 cm | |||
* ERO ≥0.40 cm2Regurgitant volume ≥45 mL | |||
* Dense continuous wave signal with triangular shape | |||
* Hepatic vein systolic flow reversal | |||
| | |||
* Dilated RV and RA | |||
* Elevated RA with “c-V” wave | |||
| | |||
* Elevated venous pressure | |||
* No symptoms | |||
|- | |||
| D || Symptomatic severe TR | |||
|Central jet ≥50% RA | |||
Vena contracta width ≥0.7 cm | |||
ERO ≥0.40 cm2Regurgitant volume ≥45 mL | |||
Dense continuous wave signal with triangular shape | |||
Hepatic vein systolic flow reversal | |||
| | |||
* Dilated RV and RA | |||
* Elevated RA with “c-V” wave | |||
| | |||
* Elevated venous pressure | |||
* Dyspnea on exertion, fatigue, ascites, edemac-V wave indicates systolic positive wave; ERO, effective regurgitant orifice; RA, right atrial; RV, right ventricular; and TR, tricuspid regurgitation. | |||
|} | |||
Shown below is a table depicting the stages of TR adapted from the 2014 AHA/ACC guidelines for management of [[valvular heart disease]].<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> | |||
<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> | |||
{|Class="wikitable" | |||
|- | |||
!style="padding: 0 5px; font-size: 100%; align=center | Stage | |||
!style="padding: 0 5px; font-size: 100%; align=center | Definition | |||
!style="padding: 0 5px; font-size: 100%; align=center | Valve anatomy | |||
!style="padding: 0 5px; font-size: 100%; align=center | Valve hemodynamics | |||
!style="padding: 0 5px; font-size: 100%; align=center | Hemodynamic consequences | |||
!style="padding: 0 5px; font-size: 100%; align=center | Symptoms of TR, left heart failure, or pulmonary vascular disease | |||
|- | |- | ||
| A || At risk || ''Primary''<br> | | A || At risk of TR || ''Primary''<br> | ||
* Mild [[rheumatic]] change | * Mild [[rheumatic]] change | ||
* Mild prolapse | * Mild [[tricuspid prolapse|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 | ||
Line 18: | Line 94: | ||
* No abnormal findings | * No abnormal findings | ||
* Beginning of annular dilation | * Beginning of annular dilation | ||
| Absent | | Absent or trace TR | ||
| Absent | | Absent | ||
| Absent | | Absent | ||
|- | |- | ||
| B || Progressive || ''Primary'' | | B || Progressive TR|| ''Primary'' | ||
* Progressive leaflet deterioration/destruction | * Progressive leaflet deterioration/destruction | ||
* Moderate-to-severe prolapse and limited chordal rupture | * Moderate-to-severe [[tricuspid prolapse|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 | * Central jet area <5.0 cm<sup>2</sup> | ||
* Undefined width of vena contracta | * Undefined width of [[vena contracta]] | ||
* Soft and parabolic CW jet density and contour | * Soft and parabolic CW jet density and contour | ||
* [[Systolic]] dominance of [[hepatic vein]] flow | * [[Systolic]] dominance of [[hepatic vein]] flow | ||
Moderate TR | Moderate TR | ||
* Central jet area 5–10 | * Central jet area 5–10 cm<sup>2</sup> | ||
* 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]]/[[right atrium|RA]]/[[IVC]] | ||
Moderate TR | Moderate TR | ||
* Absence of RV enlargement | * Absence of RV enlargement | ||
Line 45: | Line 121: | ||
* Absent or mild [[IVC]] enlargement with normal respirophasic variation | * Absent or mild [[IVC]] enlargement with normal respirophasic variation | ||
* Normal RA pressure | * Normal RA pressure | ||
| | | Absent | ||
|- | |- | ||
| C || Asymptomatic severe || ''Primary'' | | C || Asymptomatic severe TR|| ''Primary'' | ||
* Flail or grossly distorted leaflets | * Flail or grossly distorted leaflets | ||
''Secondary'' | ''Secondary'' | ||
* Severe annular dilation (>40 mm or 21 mm/ | * Severe annular dilation (>40 mm or 21 mm/m<sup>2</sup>) | ||
* Marked leaflet tethering | * Marked leaflet tethering | ||
| * Central jet area >10.0 | | * Central jet area >10.0 cm | ||
* 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]]/[[right atrium|RA]]/[[IVC]] and decreased [[IVC]] respirophasic variation | ||
* Increased RA pressure with “c-V” wave | * Increased [[right atrium|RA]] pressure with “c-V” wave | ||
* Possible diastolic interventricular [[septal]] flattening | * Possible diastolic interventricular [[septal]] flattening | ||
| | | Absent | ||
|- | |- | ||
| D || Symptomatic severe || ''Primary'' | | D || Symptomatic severe TR|| ''Primary'' | ||
* Flail or grossly distorted leaflets | * Flail or grossly distorted leaflets | ||
''Secondary'' | ''Secondary'' | ||
* Severe annular dilation (>40 mm or 21 mm/ | * Severe annular dilation (>40 mm or 21 mm/m<sup>2</sup>) | ||
* Marked leaflet tethering | * Marked leaflet tethering | ||
| * Central jet area >10.0 | | * Central jet area >10.0 cm<sup>2</sup> | ||
* 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]]/[[right atrium|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 septal flattening | ||
| Presence of symptoms ([[ | | Presence of symptoms ([[fatigue]], [[dyspnea]], [[anorexia]], [[edema]], [[abdominal distention]], [[palpitations]]) | ||
|- | |- | ||
|} | |} | ||
Line 80: | Line 156: | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} |
Latest revision as of 14:27, 8 December 2022
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Tricuspid Regurgitation Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Tricuspid regurgitation stages On the Web |
American Roentgen Ray Society Images of Tricuspid regurgitation stages |
Risk calculators and risk factors for Tricuspid regurgitation stages |
Overview
The stage of tricuspid regurgitation (TR) can be estimated based on specific criteria for the valve anatomy, valve hemodynamics, associated cardiac findings, and symptoms. The stages of TR are the following: at risk of TR, progressive TR, asymptomatic severe TR, and symptomatic severe TR.[1]
Stages
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[2]
Stages of TR
Stage | Definition | Valve hemodynamics | Hemodynamic consequences | Clinical Symptoms and Presentation |
---|---|---|---|---|
B | Progressive TR |
|
None | None |
C | Asymptomatic severe TR |
|
|
|
D | Symptomatic severe TR | Central jet ≥50% RA
Vena contracta width ≥0.7 cm ERO ≥0.40 cm2Regurgitant volume ≥45 mL Dense continuous wave signal with triangular shape Hepatic vein systolic flow reversal |
|
|
Shown below is a table depicting the stages of TR adapted from the 2014 AHA/ACC guidelines for management of valvular heart disease.[1]
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
- ↑ 1.0 1.1 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.
- ↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check
|pmid=
value (help).