CLINICAL STATEMENTS AND GUIDELINES clinical decision-making in individual patients.3 5 A weak TR signal or the presence of severe TR may result in underestimation of pulmonary systolic pressure; direct invasive measurement can resolve this uncertainty. Data from invasive measurement are essential for patients in whom the cause of pulmonary hypertension is uncertain or when assessment of pulmonary vascular reactivity after vasodilator challenge is needed. Direct measure- ments of right atrial pressure may also be useful for clinical decision-making. Right ventriculogra- phy may further aid in the evaluation of the sever- ity of TR and the status of the RV. Thermodilution cardiac output measurements may be inaccurate with severe TR, and thus a Fick cardiac output should be measured to apply to the calculation of pulmonary resistance. 8.2.2. Medical Therapy Recommendations for Medical Therapy for TR COR LOE Recommendations In patients with signs and symptoms of right-sided HF attributable to severe TR (Stages C and D), diuretics can be useful. In patients with signs and symptoms of right-sided HF attributable to severe secondary TR (Stages C and D), therapies to treat the primary cause of HF (eg, pulmonary vasodilators to reduce elevated pulmonary artery pressures, GDMT for HF with reduced LVEF, or rhythm control of AF) can be Synopsis Diuretic therapy treats the systemic congestion in pa- tients with severe symptomatic TR. In patients with sec- ondary TR, treatment of the underlying primary cause may decrease the severity of the TR. Recommendation-Specific Supportive Text 1. Patients with severe TR usually present with signs or symptoms of right-sided HF, including periph- eral edema and ascites. Low-salt diet and support stockings may be helpful. Diuretics can be used to decrease volume overload in these patients. 