Table 3.

Suggested Anatomic and Functional Parameters to Define Atrial and Ventricular Secondary Tricuspid Regurgitation^a

	A-STR Phenotypeb	V-STR Phenotypeb
Leaflet morphologyc
Tenting height (4Ch), mm	≤9	> 9
Tenting area (4Ch), cm2	<2.1	≥2.1
Tenting volume, mL	<2.5d	≥2.5
Right heart chamber sizec
RV midventricular diameter, mm	≤38d	>38
RV midventricular diameter index, mm/m2	<21	≥21
RV end-diastolic volume index, mL/m2	<80	≥80
RV end-systolic volume index, mL/m2	<21	≥21
2D sphericity indexe	<55	≥55
End-systolic RA to RV area ratioe	≥1.5	<1.5
Right ventricular systolic functionc
TAPSE, mm	>17	≤17
FAC, %	≥35	<35
RVFWS, %	≥20	<20
RV TDI S’, cm/s	≥9	<9
3D RVEF, %	≥50	<50
LVEF	≥50d	Variablef
Invasive pulmonary vascular hemodynamicsc
PCWP, mm Hg	≤15	Variablef
mPAP, mm Hg	<20	Usually >20f
PVR, WU	<2.0	Variablef

2D = 2-dimensional; 3D = 3-dimensional; 4Ch = 4-chamber view; A-STR = atrial secondary tricuspid regurgitation; FAC = fractional area change; LVEF = left ventricular ejection fraction; mPAP = mean pulmonary artery pressure; PCWP = pulmonary capillary wedge pressure; PVR = pulmonary vascular resistance; RA = right atrium/atrial; RV = right ventricle; RVEF = right ventricular ejection fraction; RVFWS = right ventricular free wall strain; TAPSE = tricuspid annular plane systolic excursion; TDI = tissue Doppler imaging; V-STR = ventricular secondary tricuspid regurgitation.

^aThis is a ctoonsensus recommendation of TVARC and the PCR Tricuspid Focus Group.

^bAssumes no primary TR or CIED-causative TR.

^cIn the setting of discordant measures within the anatomic or functional categories, an integrative approach should be used to define A-STR (absence of significant leaflet tethering in the setting of a dilated right atrium, and normal RV size and function) and V-STR (significant leaflet tethering with dilated RV). Note: within each category, the volumetric assessment and the indexed values may be preferred for research studies when available.

^dFrom Schlotter et al.¹²

^eFrom Florescu et al.⁴⁹

^fCritieria cannot be strictly defined given the heterogeneous etiologies of V-STR (ie, precapillary, postcapillary or combined precapillary/postcapillary pulmonary hypertension, and primary RV cardiomyopathies).