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The development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with heart failure and reduced left ventricular (LV) ejection fraction (HFrEF). Data are scarce concerning the right ventricular (RV) morphological and functional remodeling in HFrEF in relation to the severity of TR. Accordingly, we aimed to characterize RV remodeling in HFrEF patients with and without significant TR using three-dimensional (3D) echocardiography. We retrospectively identified 138 patients with HFrEF. In this cohort, we graded TR severity according to current guidelines and compared patients with no to mild TR (non-significant TR, n=78) versus patients with moderate to severe TR (significant TR, n=60). All patients underwent clinically indicated 3D transthoracic echocardiography. 3D LV and RV end-diastolic volumes (EDVi) and ejection fractions (EF) were measured. To characterize RV mechanical pattern, the ReVISION method was used to quantify the contribution of the longitudinal, radial, and anteroposterior motion components to total RV EF. Patients with significant TR had higher LV EDVi and lower LV EF compared with patients with non-significant TR (LV EDVi: 117.2±34.9 vs. 102.6±39.6 ml/m2; LV EF: 27.0±6.6 vs. 30.2±7.7%, both p