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The Conundrum of Tricuspid Regurgitation Grading

Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of T...

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Autores principales: Go, Yun Yun, Dulgheru, Raluca, Lancellotti, Patrizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237828/
https://www.ncbi.nlm.nih.gov/pubmed/30474032
http://dx.doi.org/10.3389/fcvm.2018.00164
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author Go, Yun Yun
Dulgheru, Raluca
Lancellotti, Patrizio
author_facet Go, Yun Yun
Dulgheru, Raluca
Lancellotti, Patrizio
author_sort Go, Yun Yun
collection PubMed
description Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm(2), regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm(2), R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm(2), R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect.
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spelling pubmed-62378282018-11-23 The Conundrum of Tricuspid Regurgitation Grading Go, Yun Yun Dulgheru, Raluca Lancellotti, Patrizio Front Cardiovasc Med Cardiovascular Medicine Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm(2), regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm(2), R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm(2), R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect. Frontiers Media S.A. 2018-11-09 /pmc/articles/PMC6237828/ /pubmed/30474032 http://dx.doi.org/10.3389/fcvm.2018.00164 Text en Copyright © 2018 Go, Dulgheru and Lancellotti. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Go, Yun Yun
Dulgheru, Raluca
Lancellotti, Patrizio
The Conundrum of Tricuspid Regurgitation Grading
title The Conundrum of Tricuspid Regurgitation Grading
title_full The Conundrum of Tricuspid Regurgitation Grading
title_fullStr The Conundrum of Tricuspid Regurgitation Grading
title_full_unstemmed The Conundrum of Tricuspid Regurgitation Grading
title_short The Conundrum of Tricuspid Regurgitation Grading
title_sort conundrum of tricuspid regurgitation grading
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237828/
https://www.ncbi.nlm.nih.gov/pubmed/30474032
http://dx.doi.org/10.3389/fcvm.2018.00164
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