Characterization of hepatic, portal, and renal venous flow patterns by Doppler ultrasound across tricuspid regurgitation grades.

Introduction and objectives: Hepatic, portal, and intrarenal venous flows are impaired in significant tricuspid regurgitation (TR), but the impact of massive and torrential TR remains unclear. This study assessed these venous flow patterns across the 5-grade TR classification and their potential as grading markers.

Methods: Patients with TR were prospectively included from 3 centers. Exclusion criteria were admission for heart failure, cirrhosis, and stage V renal disease. TR severity was classified using biplane vena contracta width and 2-dimensional effective regurgitant orifice area. Venous flow patterns (hepatic vein reverse systolic flow, portal pulsatility fraction, monophasic intrarenal flow, and reverse portal and intrarenal systolic flows) were analyzed for each TR grade.

Results: Of the 143 patients (52 grade III, 30 grade IV, 17 grade V TR), worsening TR was associated with progressively abnormal venous flow. Hepatic vein reverse flow had high sensitivity (96%) but lower specificity (73%) for grade III TR and was less useful for grades IV-V. Monophasic intrarenal flow had high specificity (97%) for grade III TR. Portal pulsatility fraction worsened with severity, with cutoffs of ≥ 40% for grade III, ≥ 80% for grade IV, and> 100% for grade V. Reverse portal and intrarenal systolic flows were highly specific for grade V (94% and 97%, respectively).

Conclusions: Increasing TR severity correlates with abnormal hepatic, portal, and intrarenal venous flow patterns, which can be assessed through routine echocardiography.