Stages of tricuspid regurgitation

Stage	Definition	Valve hemodynamics	Hemodynamic consequences	Clinical symptoms and presentation
B	Progressive TR	Central jet <50% RA Vena contracta width <0.7 cm ERO <0.40 cm² Regurgitant volume <45 mL	None	None
C	Asymptomatic severe TR	Central jet ≥50% RA Vena contracta width ≥0.7 cm ERO ≥0.40 cm² Regurgitant volume ≥45 mL Dense continuous wave signal with triangular shape Hepatic vein systolic flow reversal	Dilated RV and RA Elevated RA with "c-V" wave	Elevated venous pressure No symptoms
D	Symptomatic severe TR	Central jet ≥50% RA Vena contracta width ≥0.7 cm ERO ≥0.40 cm² Regurgitant volume ≥45 mL Dense continuous wave signal with triangular shape Hepatic vein systolic flow reversal	Dilated RV and RA Elevated RA with "c-V" wave	Elevated venous pressure Dyspnea on exertion, fatigue, ascites, edema

TR: tricuspid regurgitation; RA: right atrial; ERO: effective regurgitant orifice; RV: right ventricular; c-V wave: systolic positive wave.

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