[Functional tricuspid insufficiency in patients with severe heart failure; follow-up study using echocardiography]

We prospectively studied 104 patients with severe congestive heart failure (NYHA class III-IV) on admission and after clinical improvement. Clinical and echocardiographic data regarding the presence of secondary tricuspid incompetence were collected. Contrast echocardiographic and morphometric analyses of the inferior vena cava with determination of the diameter, the pulsation, and respiratory changes were carried out and the results were compared to those in a control group. Initially, tricuspid incompetence was present in 57% of the patients as shown by contrast echocardiography, and persisted in 34% after 31 +/- 5 days of appropriate medical treatment. In 43% of the patients, regurgitation of the tricuspid valve could not be clinically detected even though the incompetence was of moderate degree in 6 of these cases. Morphometric changes in the inferior vena cava were a sensitive indicator of the clinical response of the initiated therapy with diuretics and cardiac glycosides. The diameter of the inferior vena cava decreased from 14 +/- 0.8 mm/m2 (mean +/- SEM) to 12 +/- 0.9 mm/m2 (p less than 0.01, the systolic pulsation increased from 3.6% +/- 0.5% to 6% +/- 1% (p less than 0.05), and the respiratory change in diameter correspondingly increased from 16% +/- 3% to 26% +/- 4% (p less than 0.02). There was a linear correlation between the decrease in diameter of the inferior vena cava and in mean right atrial pressure (r = 0.734). The inspiratory increase in the right atrial V-wave was 87% +/- 8% in patients with tricuspid incompetence, whereas patients without tricuspid incompetence showed an inspiratory increase of 63% +/- 11%.(ABSTRACT TRUNCATED AT 250 WORDS)