Tricuspid regurgitation stages

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Stages

Stage	Definition	Anatomy of the valve	Hemodynamics of the valve	Hemodynamic changes	Symptoms
A	At risk	Primary TR Mild rheumatic change Mild prolapse Findings related to other conditions (IE, carcinoid, radiation) Presnece of an intra-annular RV pacemaker or ICD lead Cardiac transplant (biopsy related) Secondary TR No abnomrla findings Beginning of annular dilation	Absent	Absent	Absent
B	Progressive	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	None
C	Asymptomatic severe	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	None
D	Symptomatic severe	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)