The Conundrum of Tricuspid Regurgitation Grading
Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of T...
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doaj-3622810e400c46e98ee6f90a7a18672c2020-11-25T00:49:00ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2018-11-01510.3389/fcvm.2018.00164407306The Conundrum of Tricuspid Regurgitation GradingYun Yun Go0Raluca Dulgheru1Raluca Dulgheru2Patrizio Lancellotti3Patrizio Lancellotti4Patrizio Lancellotti5National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, SingaporeDepartment of Cardiology, University Hospital Sart Tilman, Heart Valve Clinic, University of Liège, Liège, BelgiumGIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, BelgiumDepartment of Cardiology, University Hospital Sart Tilman, Heart Valve Clinic, University of Liège, Liège, BelgiumGIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, BelgiumGruppo Villa Maria Care and Research, Anthea Hospital, Bari, ItalyFindings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm2, regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm2, R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm2, R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect.https://www.frontiersin.org/article/10.3389/fcvm.2018.00164/fulltricuspid regurgitation gradingmassive tricuspid regurgitationtorrential tricuspid regurgitationechocardiographypercutaneous intervention |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yun Yun Go Raluca Dulgheru Raluca Dulgheru Patrizio Lancellotti Patrizio Lancellotti Patrizio Lancellotti |
spellingShingle |
Yun Yun Go Raluca Dulgheru Raluca Dulgheru Patrizio Lancellotti Patrizio Lancellotti Patrizio Lancellotti The Conundrum of Tricuspid Regurgitation Grading Frontiers in Cardiovascular Medicine tricuspid regurgitation grading massive tricuspid regurgitation torrential tricuspid regurgitation echocardiography percutaneous intervention |
author_facet |
Yun Yun Go Raluca Dulgheru Raluca Dulgheru Patrizio Lancellotti Patrizio Lancellotti Patrizio Lancellotti |
author_sort |
Yun Yun Go |
title |
The Conundrum of Tricuspid Regurgitation Grading |
title_short |
The Conundrum of Tricuspid Regurgitation Grading |
title_full |
The Conundrum of Tricuspid Regurgitation Grading |
title_fullStr |
The Conundrum of Tricuspid Regurgitation Grading |
title_full_unstemmed |
The Conundrum of Tricuspid Regurgitation Grading |
title_sort |
conundrum of tricuspid regurgitation grading |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2018-11-01 |
description |
Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm2, regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm2, R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm2, R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect. |
topic |
tricuspid regurgitation grading massive tricuspid regurgitation torrential tricuspid regurgitation echocardiography percutaneous intervention |
url |
https://www.frontiersin.org/article/10.3389/fcvm.2018.00164/full |
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