Shape of TR Jet Can Help Define Severity of Regurgitation

Background: Grading the severity of function tricuspid regurgitation (fTR) is challenging. The shape of the continuous-wave (CW) Doppler signal is determined by the time-varying transvalvular gradient, which in turn is governed by flow, pressure differences, and impedance in the pulmonary circulation and right atrium. The v-wave cutoff sign has been previously described as a marker of severe tricuspid regurgitation (TR). This study explored the range of CW shapes encountered. Objective: To test the hypothesis that various envelope patterns would pair with differing severity of fTR. Methods: 245 patients with atrial and/or ventricular fTR had measurement of effective regurgitant orifice area (EROA) and regurgitant volume (RegV) by proximal isovelocity surface area (PISA) method with flow and angle corrections applied. Three types of shape analysis were applied: (1) visual, (2) ratio of maximum velocity to mean velocity (V max /V mean ), and (3) ratio time-to-peak/TR duration (TTP/TRD) more...