Diagnosis of tricuspid regurgitation: comparison of jugular venous and liver pulse tracings with combined two-dimensional and Doppler-echocardiography.

The clinical diagnosis of tricuspid regurgitation is difficult in patients after mitral valve replacement. We therefore studied the value of the jugular venous pulse tracing, liver pulse tracing and right atrial size estimated from a two-dimensional echocardiogram for diagnosing tricuspid regurgitation in 57 patients with a Björk-Shiley prosthesis in the mitral position and compared them with Doppler echocardiography. Liver pulse tracings have a higher diagnostic yield than jugular venous tracings which often have carotid pulse artifacts. The liver pulse has a sensitivity of 0.91, a specificity of 0.80. Right atrial dilatation has a sensitivity of only 0.50, but a specificity of 0.88. Likelihood ratios calculated on the basis of the combination of these two methods allow an accurate prediction of the presence or absence of tricuspid regurgitation.