Influences Of Tricuspid Insufficiency On The Spectra Of Superior Vena Cava Doppler Flow Patterns And Right Ventricular Function

Objectives1. To observe the changes of spectra of superior vena cava flow Doppler velocities in patients with tricuspid insufficiency and explore the influences of different degrees of tricuspid insufficiency on the spectrum of superior vena cava.2. Assess the right ventricular function in patients with tricuspid insufficiency by Tei index, and analyze the influences of different degrees of tricuspid insufficiency on the right ventricular function.Methods1. SubjectsSixty patients with different severity of tricuspid insufficiency due to variety of causes were recruited in this study, with male 30 and female 30 and aged 35-71 years old (mean: 47±17y). Twenty healthy volunteers with no cardiovascular disease history served as controls, with male 10 and female 10 and aged 32-70 years old (mean: 48±15y). 2. Echocardiographic examinationThe tricuspid regurgitation volumes were observed and quantified. 1) The spectrum of SVC Doppler flow and their respiratory changes were observed in the right supraclavicular fossa view and the respiratory change ratios were calculated. 2) Right ventricular Tei Index was calculated based on the measurements from anterior tricuspid annular movement by tissue Doppler imaging.Results1. Compared with the control group, the respiratory change ratio of peak velocities of S, D and their VTI did not show significant difference in patients with mild and moderate tricuspid insufficiency. With increase of the tricuspid insufficiency, the respiratory change ratio decreased. In patients with severe tricuspid insufficiency, the respiratory change ratio decreased remarkably (Peak velocity of S wave: 15.31±10.75% vs. 29.98±13.02%, P<0.05;VTI of S wave: 16.73±11.47% vs.32.70±15.16%,P<0.05).The respiratory change ratios in VR and AR waves of SVC Doppler flow velocities increased significantly in patients with moderate and severe tricuspid insufficiency (Peak velocity of AR wave: 22.21±15.25% vs.21.12±6.75%, P<0.05;VTI of AR wave:29.42±21.48% vs.24.24±26.64%; P<0.05). Changes of the spectral shape of SVC flow Doppler velocities were found in some patients with severe tricuspid insufficiency. 2. Compared with the normal group, the right ventricular IRT and ICT prolonged and ET shortened significantly, resulting in significantly higher Tei indices in patients with severe tricuspid insufficiency(0.74±0.45 vs. 0.24±0.08,P<0.05).Conclusions1. The respiratory change ratio of peak velocities of S, D and their VTI decreased remarkably and the respiratory change ratios in VR and AR waves of SVC Doppler flow velocities increased significantly in patients with severe tricuspid insufficiency compared with those in normal controls; Compared with the control group, the respiratory change ratio of peak velocities of S, D and their VTI did not show significant difference in patients with mild and moderate tricuspid insufficiency.2. Tei index increased significantly in patients with tricuspid insufficiency, proving the decreased right ventricular function. The more the tricuspid insufficiency is, the severer of the right ventricular function impairment.