Tricuspid stenosis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Tricuspid stenosis}}
{{Tricuspid stenosis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{VKG}}
== Overview ==
== Overview ==
[[Tricuspid stenosis]] (TS) is characterized by structural changes in the [[tricuspid valve]]. The most common cause of [[tricuspid stenosis]] (TS) is [[rheumatic heart disease]]. Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis which gives tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.
[[Tricuspid stenosis]] (TS) is characterized by structural changes in the [[tricuspid valve]]. The most common cause of [[tricuspid stenosis]] (TS) is [[rheumatic heart disease]]. Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis which gives tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.
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=== Study of choice ===
=== Study of choice ===


* Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis.
*[[Echocardiography]] is the gold standard test for the diagnosis of [[tricuspid stenosis]].


* The following result of echocardiography is confirmatory of tricuspid stenosis:<ref name="MorganForker1971">{{cite journal|last1=Morgan|first1=Jacob R.|last2=Forker|first2=Alan D.|last3=Coates|first3=J. R.|last4=Myers|first4=W. S.|title=Isolated Tricuspid Stenosis|journal=Circulation|volume=44|issue=4|year=1971|pages=729–732|issn=0009-7322|doi=10.1161/01.CIR.44.4.729}}</ref><ref name="FinneganAbrams1973">{{cite journal|last1=Finnegan|first1=P|last2=Abrams|first2=L D|title=Isolated tricuspid stenosis.|journal=Heart|volume=35|issue=11|year=1973|pages=1207–1210|issn=1355-6037|doi=10.1136/hrt.35.11.1207}}</ref><ref name="BaumgartnerHung2009">{{cite journal|last1=Baumgartner|first1=Helmut|last2=Hung|first2=Judy|last3=Bermejo|first3=Javier|last4=Chambers|first4=John B.|last5=Evangelista|first5=Arturo|last6=Griffin|first6=Brian P.|last7=Iung|first7=Bernard|last8=Otto|first8=Catherine M.|last9=Pellikka|first9=Patricia A.|last10=Quiñones|first10=Miguel|title=Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice|journal=Journal of the American Society of Echocardiography|volume=22|issue=1|year=2009|pages=1–23|issn=08947317|doi=10.1016/j.echo.2008.11.029}}</ref>
* The following result of [[echocardiography]] is confirmatory of [[tricuspid stenosis]]:<ref name="MorganForker1971">{{cite journal|last1=Morgan|first1=Jacob R.|last2=Forker|first2=Alan D.|last3=Coates|first3=J. R.|last4=Myers|first4=W. S.|title=Isolated Tricuspid Stenosis|journal=Circulation|volume=44|issue=4|year=1971|pages=729–732|issn=0009-7322|doi=10.1161/01.CIR.44.4.729}}</ref><ref name="FinneganAbrams1973">{{cite journal|last1=Finnegan|first1=P|last2=Abrams|first2=L D|title=Isolated tricuspid stenosis.|journal=Heart|volume=35|issue=11|year=1973|pages=1207–1210|issn=1355-6037|doi=10.1136/hrt.35.11.1207}}</ref><ref name="BaumgartnerHung2009">{{cite journal|last1=Baumgartner|first1=Helmut|last2=Hung|first2=Judy|last3=Bermejo|first3=Javier|last4=Chambers|first4=John B.|last5=Evangelista|first5=Arturo|last6=Griffin|first6=Brian P.|last7=Iung|first7=Bernard|last8=Otto|first8=Catherine M.|last9=Pellikka|first9=Patricia A.|last10=Quiñones|first10=Miguel|title=Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice|journal=Journal of the American Society of Echocardiography|volume=22|issue=1|year=2009|pages=1–23|issn=08947317|doi=10.1016/j.echo.2008.11.029}}</ref>
**The degree of thickening of tricuspid valve leaflets
**The degree of thickening of [[Tricuspid valve|tricuspid]] valve leaflets
**Calcification of tricuspid valve leaflets
**[[Calcification]] of [[tricuspid valve]] leaflets
**Limited leaflet mobility of tricuspid valve leaflets
**Limited leaflet mobility of [[tricuspid valve]] leaflets
**Reduced separation of the tricuspid valve leaflet tips
**Reduced separation of the [[tricuspid valve]] leaflet tips
**Diastolic doming of the tricuspid valve
**[[Diastole|Diastolic]] doming of the [[tricuspid valve]]
**Echocardiography gives the degree of fusion of the commissures and chordae tendineae of the tricuspid valve
**[[Echocardiography]] gives the degree of fusion of the [[commissures]] and [[chordae tendineae]] of the [[tricuspid valve]]


OR
[[File:Normal echocardiographic appearance of tricuspid valve.jpg|center|thumb|709x709px|Normal echocardiographic appearance of tricuspid valve (''arrow'') and wave pattern. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
[[File:Tricuspid stenosis in echocardiography.jpg|alt=Tricuspid stenosis in echocardiography|center|thumb|709x709px|Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (''arrow'') and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028338/|title=Multimodal imaging of the tricuspid valve: normal appearance and pathological entities|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]


[Name of the investigation] must be performed when:
=== Staging of Tricuspid stenosis ===
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
* Based on the valve anatomy, hemodynamics, and consequences tricuspid stenosis can be staged into the following:<ref name="NishimuraOtto2014">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease|journal=Journal of the American College of Cardiology|volume=63|issue=22|year=2014|pages=e57–e185|issn=07351097|doi=10.1016/j.jacc.2014.02.536}}</ref><ref name="NishimuraOtto2017">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Fleisher|first6=Lee A.|last7=Jneid|first7=Hani|last8=Mack|first8=Michael J.|last9=McLeod|first9=Christopher J.|last10=O’Gara|first10=Patrick T.|last11=Rigolin|first11=Vera H.|last12=Sundt|first12=Thoralf M.|last13=Thompson|first13=Annemarie|title=2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines|journal=Circulation|volume=135|issue=25|year=2017|issn=0009-7322|doi=10.1161/CIR.0000000000000503}}</ref><ref name="NishimuraOtto20142">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O'Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Journal of the American College of Cardiology|volume=63|issue=22|year=2014|pages=2438–2488|issn=07351097|doi=10.1016/j.jacc.2014.02.537}}</ref><ref name="NishimuraOtto20144">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary|journal=Circulation|volume=129|issue=23|year=2014|pages=2440–2492|issn=0009-7322|doi=10.1161/CIR.0000000000000029}}</ref><ref name="NishimuraOtto20143">{{cite journal|last1=Nishimura|first1=Rick A.|last2=Otto|first2=Catherine M.|last3=Bonow|first3=Robert O.|last4=Carabello|first4=Blase A.|last5=Erwin|first5=John P.|last6=Guyton|first6=Robert A.|last7=O’Gara|first7=Patrick T.|last8=Ruiz|first8=Carlos E.|last9=Skubas|first9=Nikolaos J.|last10=Sorajja|first10=Paul|last11=Sundt|first11=Thoralf M.|last12=Thomas|first12=James D.|title=2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease|journal=Circulation|volume=129|issue=23|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000031}}</ref>


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
{| class="wikitable"
 
!Stage
OR
! Definition
 
!Valve anatomy
The diagnostic study of choice for [disease name] is [name of the investigation].
!Valve hemodynamics
 
!Hemodynamic consequences
OR
!Symptoms
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
|C, D
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|Severe TS
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|Thickened, distorted, [[Calcification|calcified]] leaflets
|-
|
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
*T ½ ≥190 ms 
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
*[[Valve]] area ≤1.0 cm2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|Right atrial / [[Inferior vena cava]] enlargement
|
*Stage C-No [[symptoms]]
*Stage D-[[Symptom|Symptoms]] variable and dependent on the severity of associated valve disease and degree of obstruction
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''


There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 14:07, 1 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Tricuspid stenosis (TS) is characterized by structural changes in the tricuspid valve. The most common cause of tricuspid stenosis (TS) is rheumatic heart disease. Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis which gives tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.

Diagnostic Study of Choice

Study of choice

Normal echocardiographic appearance of tricuspid valve (arrow) and wave pattern. Case courtesy by Soham Shah et al[4]
Tricuspid stenosis in echocardiography
Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (arrow) and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al[5]

Staging of Tricuspid stenosis

  • Based on the valve anatomy, hemodynamics, and consequences tricuspid stenosis can be staged into the following:[6][7][8][9][10]
Stage Definition Valve anatomy Valve hemodynamics Hemodynamic consequences Symptoms
C, D Severe TS Thickened, distorted, calcified leaflets
  • T ½ ≥190 ms 
  • Valve area ≤1.0 cm2
 Right atrial / Inferior vena cava enlargement
  • Stage C-No symptoms
  • Stage D-Symptoms variable and dependent on the severity of associated valve disease and degree of obstruction


References

  1. ↑ Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). "Isolated Tricuspid Stenosis". Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.
  2. ↑ Finnegan, P; Abrams, L D (1973). "Isolated tricuspid stenosis". Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.
  3. ↑ Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). "Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice". Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.
  4. ↑ "Multimodal imaging of the tricuspid valve: normal appearance and pathological entities".
  5. ↑ "Multimodal imaging of the tricuspid valve: normal appearance and pathological entities".
  6. ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease". Journal of the American College of Cardiology. 63 (22): e57–e185. doi:10.1016/j.jacc.2014.02.536. ISSN 0735-1097.
  7. ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Fleisher, Lee A.; Jneid, Hani; Mack, Michael J.; McLeod, Christopher J.; O’Gara, Patrick T.; Rigolin, Vera H.; Sundt, Thoralf M.; Thompson, Annemarie (2017). "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. 135 (25). doi:10.1161/CIR.0000000000000503. ISSN 0009-7322.
  8. ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O'Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Journal of the American College of Cardiology. 63 (22): 2438–2488. doi:10.1016/j.jacc.2014.02.537. ISSN 0735-1097.
  9. ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
  10. ↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease". Circulation. 129 (23). doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.

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