Stages of TR Stage Definition Valve Hemodynamics Hemodynamic Consequences Clinical Symptoms and Presentation B Progressive TR Central jet <50% RA Vena contracta width <0.7 cm Regurgitant volume <45 mL None None C Asymptomatic severe TR Central jet 50% RA Vena contracta width 0.7 cm 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 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 c-V wave indicates systolic positive wave; ERO, effective regurgitant orifice; RA, right atrial; RV, right ventricular; and TR, tricuspid regurgitation. CLINICAL STATEMENTS AND GUIDELINES 8.2.3. Timing of Intervention Recommendations for Timing of Intervention Referenced studies that support the recommendations are summarized in Online Data Supplement 32. 