A delayed time of the peak tricuspid regurgitation signal: Marker of right ventricular dysfunction

Background: Worsening degrees of tricuspid regurgitation (TR) have been associated with worse outcomes. We investigated the time it takes for the TR jet to attain its maximum peak (tmpTR) with measures of right ventricular (RV) function. Methods: Several echocardiographic variables of RV size and function and tmpTR corrected for heart rate were collected from 140 patients (mean age 57 ± 20 years). Results: Mean RV end systolic (15 ± 9 cm) and end diastolic (25 ± 9 cm) areas, RV fractional area change (44 ± 19%), maximal tricuspid annular motion (1.98 ± 0.71 cm), pulmonary artery systolic pressure (57 ± 33 mm Hg) and tmpTR (248 ± 75 ms). A negative correlation was seen between tmpTR and RV fractional area change (r =-0.74; P < 0.0001) and between tmpTR and maximal tricuspid annular excursion (r =-0.69; P < 0.0001). On a multiple stepwise linear regression analysis tmpTR was better than pulmonary artery systolic pressure in predicting RV dysfunction (P < 0.001). Receiver operating characteristic curve analysis demonstrated that a tmpTR value >240 ms identified RV systolic dysfunction (sensitivity 79% and specificity 94%, areas under the curves 0.923, P = 0.0001). The longest tmpTR values were seen in patients with both RV systolic dysfunction and pulmonary hypertension (310 ± 30 ms, P < 0.0001). Conclusion: A delayed time to peak of the maximum TR jet correlates with RV dysfunction. Patients with normal RV function and no pulmonary hypertension had abnormal tmpTR values (243 ± 57 ms) implying an underlying RV mechanical abnormality that requires further investigation.