Tricuspid regurgitation: standardized stepwise work-up from referral to expert heart valve centre

Tricuspid regurgitation (TR) is a common yet historically neglected condition associated with poor outcomes. Traditionally managed conservatively, TR has recently gained renewed attention, thanks to advances in surgical and transcatheter interventions. Selecting the optimal therapy, however, requires an integrated and systematic approach considering TR aetiology, stage of the disease, comorbidities, operative risk, and anatomical feasibility. This review describes a standardized stepwise work-up for patients with TR from the referral centre to the expert heart valve centre (HVC). It provides practical algorithms and structured protocols covering clinical and biological assessment, multimodality imaging (echocardiography, computed tomography, cardiac magnetic resonance), and invasive haemodynamic evaluation. The document highlights the importance of multidisciplinary collaboration, involving imagers, heart failure specialists, interventional cardiologists, electrophysiologists, and surgeons, in line with the new recommendations of the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. By harmonizing diagnostic standards and promoting a structured approach to patient assessment within HVCs, this review aims to facilitate timely referral and ensure consistent evaluation and management of patients with this complex and often underestimated condition.

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Publication Details

Journal
European Heart Journal
Published
2026-03-28
DOI
https://doi.org/10.1093/eurheartj/ehag214
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
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article

Tricuspid regurgitation: standardized stepwise work-up from referral to expert heart valve centre

E. Donal, Julia Grapsa, Haran Burri, B D Prendergast et al.
European Heart Journal
Cardiac Valve Diseases and Treatments
article

Tricuspid regurgitation: standardized stepwise work-up from referral to expert heart valve centre

E. Donal, Julia Grapsa, Haran Burri, B D Prendergast, K P Kresoja, Marco Metra, Marianna Adamo, Rebecca Hahn, Davide Margonato, Julien Dreyfus, Eustachio Agricola, Nina Ajmone Marsan, Francesco Maisano, Marta Sitges, Augustin Coisne, David Messika-Zeitoun, Fabien Praz, Denisa Muraru, Joao Cavalcante, Mirjam Wild, Jeroen J. Bax
article en

Abstract

Tricuspid regurgitation (TR) is a common yet historically neglected condition associated with poor outcomes. Traditionally managed conservatively, TR has recently gained renewed attention, thanks to advances in surgical and transcatheter interventions. Selecting the optimal therapy, however, requires an integrated and systematic approach considering TR aetiology, stage of the disease, comorbidities, operative risk, and anatomical feasibility. This review describes a standardized stepwise work-up for patients with TR from the referral centre to the expert heart valve centre (HVC). It provides practical algorithms and structured protocols covering clinical and biological assessment, multimodality imaging (echocardiography, computed tomography, cardiac magnetic resonance), and invasive haemodynamic evaluation. The document highlights the importance of multidisciplinary collaboration, involving imagers, heart failure specialists, interventional cardiologists, electrophysiologists, and surgeons, in line with the new recommendations of the 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. By harmonizing diagnostic standards and promoting a structured approach to patient assessment within HVCs, this review aims to facilitate timely referral and ensure consistent evaluation and management of patients with this complex and often underestimated condition.

European Heart Journal
University of Bern (CH), Brigham and Women's Hospital (US), Abbott Northwestern Hospital (US), University of Ottawa (CA), Vita-Salute San Raffaele University (IT), Inserm (FR), Johannes Gutenberg University Mainz (DE), Columbia University Irving Medical Center (US), Leiden University Medical Center (NL), Institut Pasteur de Lille (FR), University Hospital of Bern (CH), University Medical Center Freiburg (DE), Instituto de Salud Carlos III (ES), San Raffaele University of Rome (IT), University Medical Center of the Johannes Gutenberg University Mainz (DE), Surgical Specialties (Canada) (CA), University Hospital of Geneva (CH), NIHR Imperial Biomedical Research Centre (GB), Hospital Clínic de Barcelona (ES), IRCCS Ospedale San Raffaele (IT), Minneapolis Heart Institute Foundation (US), IRCCS Istituto Auxologico Italiano (IT), Ottawa Public Health (CA), Cardiovascular Research Foundation (US), Cleveland Clinic London (GB), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Centre Cardiologique du Nord (FR), Imperial College London (GB), Université de Rennes (FR), University of Milano-Bicocca (IT), Universitat de Barcelona (ES), University of Brescia (IT)
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Openalex Percentile: Top 9%
Cardiac Valve Diseases and Treatments
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