Table 7 Stages of TR

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 radius^a (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