Echocardiographic assessment of the degree of tricuspid insufficiency in determining the severity of pulmonary embolism

The need to develop new non-invasive criteria for overload of the right heart in patients with pulmonary embolism. Aims: to develop new methods for assessing blood regurgitation on the tricuspid valve during systole of the right ventricle, and to evaluate their capabilities as criteria for the severity and prognosis of the disease. Materials and methods: the study included 428 patients with pulmonary embolism: 42 patients with fatal outcome, 244 patients with presence and 142 with absence of signs of overload of the right heart. The degree of tricuspid regurgitation was determined in all patients and its prevalence in the compared groups was analyzed, as well as its relationship with the expansion of the inferior vena cava more than 2 cm and the absence of its collapse on inspiration by 50%. The volume of tricuspid regurgitation and its ratio to the volume of the right atrium and the volume of blood ejection per systole, as well as the calculation of the heart’s work on the tricuspid valve, with the establishment of threshold values and their significance, are determined in each patient. Results: It was found that the use of the degree of tricuspid regurgitation is significantly less informative and visual than its volume, the calculation of which, by the proposed method, is completely comparable with pathophysiological data. Significant threshold values, the excess of which was associated with the manifestation of hemodynamically significant pulmonary embolism for the ratio of tricuspid regurgitation volume to the volume of the right atrium and to the heart stroke volume, as well as for the work of the right ventricle on the tricuspid valve were 0.6, 1 and 0.5, respectively, the same values indicated the possible development of an unfavorable outcome of the disease. Conclusions: the developed assessment methods more informatively and clearly reflect the severity of overload of the right parts of the heart and its compensation.