Tricuspid regurgitation thresholds reassessed

The proposed framework classified 30% of patients as high or extreme risk, compared with 12% classified as having severe or greater tricuspid regurgitation under established grading schemes.

By
Kathryn Wighton
September 9, 2026
4 min

MDSpire News

Overview

A study published in JAMA Cardiology identified disease-specific echocardiographic thresholds for tricuspid regurgitation in patients with transthyretin amyloid cardiomyopathy. The study involved 1,124 patients and established new risk thresholds for tricuspid regurgitation measurements.

Background

Tricuspid regurgitation (TR) is a significant clinical condition that can impact patient outcomes, particularly in those with transthyretin amyloid cardiomyopathy. A reassessment of risk thresholds is necessary to improve patient management.

Data Highlights

Threshold Category	Vena Contracta Width (mm)	Effective Regurgitant Orifice Area (cm²)	Regurgitant Volume (mL)
Intermediate Risk	3	0.15	10
High Risk	5	0.25	20
Extreme Risk	8	0.50	40

Key Findings

The study included 1,124 patients with a median age of 80 years, of whom 23% were female.
New thresholds for TR were established: 3 mm (intermediate), 5 mm (high), and 8 mm (extreme) for vena contracta width.
During a median follow-up of 25 months, 29% of patients died and 22% experienced heart failure hospitalization.
The proposed framework classified 37% of patients as low risk, 34% as intermediate risk, 21% as high risk, and 9% as extreme risk.
Kaplan-Meier analyses demonstrated stepwise separation in mortality across the risk categories.
The new framework showed significantly greater discrimination than existing guidelines from 24 months onward in the validation cohort.

Clinical Implications

Clinicians should consider the newly established thresholds when evaluating TR severity and associated risks in patients with transthyretin amyloid cardiomyopathy.