Health Dictionary

Overview

The stage of tricuspid regurgitation (TR) can be estimated based on specific criteria for the valve anatomy, valve hemodynamics, associated cardiac findings, and symptoms. The stages of TR are the following: at risk of TR, progressive TR, asymptomatic severe TR, and symptomatic severe TR.^[1]

Stages

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[2]

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines^[2]

Stages of TR

Stage	Definition	Valve hemodynamics	Hemodynamic consequences	Clinical Symptoms and Presentation
B	Progressive TR	Central jet <50% RA Vena contracta width <0.7 cm ERO <0.40 cm2 Regurgitant volume <45 mL	None	None
C	Asymptomatic severe TR	Central jet ≥50% RA Vena contracta width ≥0.7 cm ERO ≥0.40 cm2Regurgitant volume ≥45 mL Dense continuous wave signal with triangular shape Hepatic vein systolic flow reversal	Dilated RV and RA Elevated RA with “c-V” wave	Elevated venous pressure No symptoms
D	Symptomatic severe TR	Central jet ≥50% RA Vena contracta width ≥0.7 cm ERO ≥0.40 cm2Regurgitant volume ≥45 mL Dense continuous wave signal with triangular shape Hepatic vein systolic flow reversal	Dilated RV and RA Elevated RA with “c-V” wave	Elevated venous pressure Dyspnea on exertion, fatigue, ascites, edemac-V wave indicates systolic positive wave; ERO, effective regurgitant orifice; RA, right atrial; RV, right ventricular; and TR, tricuspid regurgitation.

Shown below is a table depicting the stages of TR adapted from the 2014 AHA/ACC guidelines for management of valvular heart disease.^[1]

Abbreviations: CW: continuous wave; ICD: implantable cardioverter-defibrillator; IE: infective endocarditis; IVC: inferior vena cava; RA: right atrium; RV: right ventricle; TR: tricuspid regurgitation

Stage	Definition	Valve anatomy	Valve hemodynamics	Hemodynamic consequences	Symptoms of TR, left heart failure, or pulmonary vascular disease
A	At risk of TR	Primary Mild rheumatic change Mild prolapse Findings related to other conditions (IE, carcinoid, radiation) Presence of an intra-annular RV pacemaker or ICD lead Cardiac transplant (biopsy related) Secondary No abnormal findings Beginning of annular dilation	Absent or trace TR	Absent	Absent
B	Progressive TR	Primary Progressive leaflet deterioration/destruction Moderate-to-severe prolapse and limited chordal rupture Secondary Beginning of annular dilation Moderate leaflet tethering	Mild TR Central jet area <5.0 cm² Undefined width of vena contracta Soft and parabolic CW jet density and contour Systolic dominance of hepatic vein flow Moderate TR Central jet area 5–10 cm² Undefined width of vena contracta width but <0.70 cm Dense, variable CW jet density and contour Systolic blunting of hepatic vein flow	Mild TR Normal size of RV/RA/IVC Moderate TR Absence of RV enlargement Absent or mild RA enlargement Absent or mild IVC enlargement with normal respirophasic variation Normal RA pressure	Absent
C	Asymptomatic severe TR	Primary Flail or grossly distorted leaflets Secondary Severe annular dilation (>40 mm or 21 mm/m²) Marked leaflet tethering	* Central jet area >10.0 cm ²* Vena contracta width >0.7 cm Dense, triangular CW jet density and contour with early peak Systolic reversal in hepatic vein flow	* Dilated RV/RA/IVC and decreased IVC respirophasic variation Increased RA pressure with “c-V” wave Possible diastolic interventricular septal flattening	Absent
D	Symptomatic severe TR	Primary Flail or grossly distorted leaflets Secondary Severe annular dilation (>40 mm or 21 mm/m²) Marked leaflet tethering	* Central jet area >10.0 cm² Vena contracta width >0.7 cm Dense, triangular CW jet density and contour with early peak Systolic reversal in hepatic vein flow	* Dilated RV/RA/IVC and decreased IVC respirophasic variation Increased RA pressure with “c-V” wave Possible diastolic interventricular septal flattening	Presence of symptoms (fatigue, dyspnea, anorexia, edema, abdominal distention, palpitations)

References

↑ ^1.0 ^1.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines”. Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). “2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).

[pmid24589852-1] 1.0 ^1.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines”. Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.

[pmid33332150-2] Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). “2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).

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Health Dictionary

Tricuspid regurgitation stages

Introduction

Overview

Stages

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines^[2]

Stages of TR

References