End-organ damage, such as hepatic failure and renal failure, is an adverse consequence of Stage D TR that markedly affects survival.19 23 The severity of TR can be dynamic and dependent on changes in preload and pulmonary pressure. 8.2. Tricuspid Regurgitation 8.2.1. Diagnosis of TR Recommendations for Diagnosis of TR COR LOE Recommendations In patients with TR, TTE is indicated to evaluate the presence and severity of TR, determine the etiology, measure the sizes of the right- sided chambers and inferior vena cava, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease.1,2 In patients with TR, invasive measurement of the cardiac index, right-sided diastolic pressures, pulmonary artery pressures, and pulmonary vascular resistance, as well as right ventriculography, can be useful when clinical and noninvasive data are discordant or Synopsis TTE can determine the etiology of TR and its effect on the RV. Cardiac catheterization is of clinical value if the information from TTE is inadequate or discordant with the clinical presentation.6 10 Recommendation-Specific Supportive Text 1. TTE can distinguish primary TR (abnormal valve leaflets) from secondary TR (normal valve leaf- lets), define any associated left-sided valvular or myocardial disease, and provide an estimate of pulmonary artery systolic pressure.11 15 Characterization of the severity of TR relies on an integrative assessment of multiple param- eters, as recommended by the American Society of Echocardiography and European Association but many limitations remain. In patients with TR undergoing left- sided valve surgery, an annular diastolic diameter ) indicates an increased risk of persistent or progressive TR after isolated mitral valve surgery.13 Pulmonary artery systolic pressure is estimated from maximal TR velocity. 