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CLINICAL STUDIES

Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study

Christophe M. Tribouilloy, MD^*, Maurice Enriquez-Sarano, MD^*, Kent R. Bailey, PhD, A. Jamil Tajik, MD^* and James B. Seward, MD^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received September 3, 1999; revised manuscript received February 11, 2000, accepted March 30, 2000.

Reprint requests and correspondence: Dr. Maurice Enriquez-Sarano, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905

OBJECTIVE

We sought to evaluate the vena contracta width (VCW) measured using color Doppler as an index of severity of tricuspid regurgitation (TR).

BACKGROUND

The VCW is a reliable measure of mitral and aortic regurgitation, but its value in measuring TR is uncertain.

METHODS

In 71 consecutive patients with TR, the VCW was prospectively measured using color Doppler and compared with the results of the flow convergence method and hepatic venous flow, and its diagnostic value for severe TR was assessed.

RESULTS

The VCW was 6.1 ± 3.4 mm and was significantly higher in patients with, than those without, severe TR (9.6 ± 2.9 vs. 4.2 ± 1.6 mm, p < 0.0001). The VCW correlated well with the effective regurgitant orifice (ERO) by the flow convergence method (r = 0.90, SEE = 0.17 cm², p < 0.0001), even when restricted to patients with eccentric jets (r = 0.93, p < 0.0001). The VCW also showed significant correlations with hepatic venous flow (r = 0.79, p < 0.0001), regurgitant volume (r = 0.77, p < 0.0001) and right atrial area (r = 0.46, p < 0.0001). A VCW 6.5 mm identified severe TR with 88.5% sensitivity and 93.3% specificity. In comparison with jet area or jet/right atrial area ratio, the VCW showed better correlations with ERO (both p < 0.01) and a larger area under the receiver operating characteristic curve (0.98 vs. 0.88 and 0.85, both p < 0.02) for the diagnosis of severe TR.

CONCLUSIONS

The VCW measured by color Doppler correlates closely with severity of TR. This quantitative method is simple, provides a high diagnostic value (superior to that of jet size) for severe TR and represents a useful tool for comprehensive, noninvasive quantitation of TR.

Abbreviations and Acronyms   ERO = effective regurgitant orifice   PISA = proximal isovelocity surface area   r = radius   RA = right atrium   RFlow = midsystolic instantaneous regurgitant flow   ROC = receiver operating characteristic   TR = tricuspid regurgitation   V = peak tricuspid regurgitant velocity from continuous-wave Doppler   VCW = color Doppler width of the vena contracta   Vr = aliasing velocity

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