EACVI Survey on the Current Multi-Modality Imaging Practice in Patients with Tricuspid Regurgitation

AIMS: This European Association of Cardiovascular Imaging (EACVI) survey evaluated current practice patterns in the imaging assessment of tricuspid regurgitation (TR), focusing on conventional and advanced modalities, the adoption of recent classifications, and barriers to quantitative right heart assessment.

METHODS AND RESULTS: A 25-item online questionnaire was launched during EuroEcho Imaging 2024 and distributed via EACVI channels. From 10 December 2024 to 3 July 2025, 530 respondents from 69 countries participated. Most worked in tertiary/university hospitals (62%) and were imaging specialists (41%) or clinical cardiologists (40%). Transthoracic echocardiography (TTE) was almost universally applied (96%), while use of transoesophageal (TOE) and 3D echocardiography was variable. Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (RVFAC) were frequently used, but RV strain and ejection fraction were underutilized due to time constraints and software unavailability. TR quantification relied mainly on colour Doppler-based parameters, with advanced approaches-3D colour Doppler, cardiac magnetic resonance (CMR)-reserved for selected patients. Half of the respondents routinely applied the 5-grade TR severity scheme, and leaflet-based anatomical classification was inconsistently adopted. Cardiac computed tomography, CMR, and invasive haemodynamics were more often used in patients referred for transcatheter interventions.

CONCLUSION: This EACVI survey highlights considerable heterogeneity in TR imaging practice, with increasing yet slow adoption of robust quantitative and advanced modalities for assessing TR severity and right heart morphology/function. These findings underscore the need for improved access to advanced imaging technologies and broader dissemination of contemporary standards to enhance the quality and consistency of TR imaging in clinical and research settings.