Table 7.
Stages of TR
| Characteristic | Stage | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| A | B | C | D | ||||||
| Definition | At risk | Progressive | Asymptomatic severe | Symptomatic severe | |||||
| Severity | Normal to trivial | Mild | Moderate | Severe | Massive | Torrential | |||
| Echocardiography morphology | |||||||||
| Leaflet | Normal | Mild to moderate thickening | Severe thickening, flail, perforation, retraction | ||||||
| Coaptation | Normal, CIED, AF | Limited, prolapse, lead impingement | Severe loss, prolapse | ||||||
| Annulus | Normal | Dilation | Dilation | ||||||
| VCW (mm) | - | < 3 | 3–6 | 7–13 | 14–20 | ≥ 21 | |||
| EROA (cm2) | - | < 0.2 | 0.2–0.4 | 0.4–0.6 | 0.6–0.8 | ≥ 0.8 | |||
| PISA radiusa (mm) | - | ≤ 5 | 6–8 | ≥ 9 | |||||
| Regurgitant volume (mL) | - | < 30 | 30–45 | 45–59 | 60–74 | ≥ 75 | |||
| Regurgitant fraction (%) | - | < 30 | 30–49 | ≥ 50 | |||||
| RA/RV size | - | Normal or ↑ | ↑ | ||||||
| Hepatic vein flow | - | Systolic dominance | Systolic blunting | Systolic flow reversal | |||||
| TR-CW Doppler jet | - | Faint/ parabolic | Dense/ parabolic | Dense, triangular | |||||
| Symptom | None | None | None | DOE, EI, right HF | |||||
TR Tricuspid regurgitation, CIED Cardiac implantable electronic devices, AF Atrial fibrillation, VCW Vena contracta width, EROA Effective regurgitant orifice area by 2D-PISA method, PISA Proximal isovelocity surface area, RA Right atrium, RV Right ventricle, CW Continuous wave, DOE Dyspnea on exertion, EI Exercise intolerance, HF Right heart failure
aRadius at Nyquist limit shift of 28 cm/sec