High-Risk Tricuspid Regurgitation: The Case for CMR-Based Precision
For decades, tricuspid regurgitation (TR) was often dismissed as a secondary consequence of left-sided heart disease—the so-called ‘forgotten valve.’ However, the emergence of transcatheter tricuspid valve interventions (TTVIs) has catalyzed a paradigm shift, necessitating more precise diagnostic and prognostic tools. While transthoracic echocardiography (TTE) remains the first-line screening modality, its limitations in quantifying TR—particularly due to the complex, non-planar geometry of the tricuspid annulus and the challenges of acoustic windows—are well-documented.
Recent evidence published in Circulation by Margonato et al. (2025) suggests that Cardiac Magnetic Resonance (CMR) imaging may offer the definitive solution for identifying high-risk patients. By utilizing tricuspid regurgitant fraction (TRF) and parametric mapping of the liver, clinicians can now move beyond qualitative ‘mild-to-severe’ labels toward a quantitative, data-driven risk stratification model that correlates directly with patient survival and hospitalization rates.
