Why we need treatment? Prognosis of tricuspid regurgitation

Tricuspid regurgitation (TR) has historically been under-recognized in clinical practice, yet growing evidence highlights its significant impact on prognosis, particularly in its severe forms. Severe TR is indeed associated with increased mortality and heart failure hospitalizations, with prognostic deterioration further stratified by emerging classifications such as 'massive' and 'torrential' TR. Accurate assessment of TR severity is essential for timely referral and management decisions. Traditional echocardiographic parameters-such as tricuspid annular plane systolic excursion and right ventricular (RV) fractional area change-are limited by their load-dependence, prompting growing interest in advanced imaging modalities such as strain imaging and cardiac magnetic resonance for more precise evaluation of RV function. In this setting, medical management remains only supportive, with diuretics and neurohormonal modulation forming the cornerstone of therapy, especially in patients with heart failure. However, evidence for pharmacological interventions specific to TR is limited. Surgical treatment is indicated in select patients, though associated with high perioperative risk, necessitating careful patient selection. In recent years, transcatheter tricuspid valve interventions have emerged as promising alternatives for high-risk patients, including edge-to-edge repair (T-TEER) and orthotopic tricuspid valve replacement, and also caval valve implantation is being explored for anatomically complex or high-risk cases. Early recognition, comprehensive risk assessment, and individualized therapeutic planning-including consideration of timely intervention-are crucial to improving outcomes in this often-neglected valvular condition.