Grapsa, Julia, Praz, Fabien, Sorajja, Paul, Cavalcante, Joao L., Sitges, Marta, Taramasso, Maurizio, Piazza, Nicolo, Messika-Zeitoun, David, Michelena, Hector I., Hamid, Nadira, Dreyfus, Julien, Benfari, Giovanni, Argulian, Edgar, Chieffo, Alaide, Tchetche, Didier, Rudski, Lawrence, Bax, Jeroen J., Stephan von Bardeleben, Ralph, Patterson, Tiffany, and Redwood, Simon
Tricuspid regurgitation (TR) is a highly prevalent and heterogeneous valvular disease, independently associated with excess mortality and high morbidity in all clinical contexts. TR is profoundly undertreated by surgery and is often discovered late in patients presenting with right-sided heart failure. To address the issue of undertreatment and poor clinical outcomes without intervention, numerous structural tricuspid interventional devices have been and are in development, a challenging process due to the unique anatomic and physiological characteristics of the tricuspid valve, and warranting well-designed clinical trials. The path from routine practice TR detection to appropriate TR evaluation, to conduction of clinical trials, to enriched therapeutic possibilities for improving TR access to treatment and outcomes in routine practice is complex. Therefore, this paper summarizes the key points and methods crucial to TR detection, quantitation, categorization, risk-scoring, intervention-monitoring, and outcomes evaluation, particularly of right-sided function, and to clinical trial development and conduct, for both interventional and surgical groups. [Display omitted] • TR is profoundly undertreated by surgery and is often discovered late in patients presenting with right-sided heart failure. This review sheds light on the multimodality imaging of TR, the existing gaps in the published reports, and how to optimize outcomes of clinical trials. • TR detection, quantitation, categorization, risk-scoring, intervention-monitoring, and outcomes evaluation, particularly of right-sided function, are crucial for the appropriate management of these patients and for clinical trial development and conduct, for both interventional and surgical groups. • Protocolized care with routine standardized definition of TR causes/mechanisms and application of standardized quantitative methods to measure TR is a crucial step. Beyond the cursory assessment of cardiac remodeling and RV function, cardiac CT and MRI quantification represent crucial steps that warrant establishing rigorous sequences applicable in routine practice. [ABSTRACT FROM AUTHOR]