Accurate quantification of TR remains a clinical challenge, often leading to underestimation of disease severity and delayed treatment. A study published in European Heart Journal – Cardiovascular Imaging demonstrates that CMR can more precisely capture the hemodynamic and structural consequences of TR.

The analysis included 335 patients who underwent comprehensive CMR evaluation with TRF quantification. The median TRF was 21% (interquartile range, 13–33%), encompassing a wide spectrum of TR severity. TRF showed strong concordance with echocardiographic signs of severe TR (p < 0.001) and correlated with markers of right-sided heart failure, including liver dysfunction biomarkers and elevated CMR-derived liver extracellular volume.

Patients with TRF ≥20% exhibited evidence of early right ventricular maladaptive remodeling, reflected by higher right ventricular end-diastolic volume and reduced TAPSE/PASP ratio, both key prognostic indicators. TRF also aligned closely with the TRISCORE, further validating its prognostic relevance.

These findings suggest that CMR-derived TRF provides a more physiologically meaningful assessment of TR severity than conventional methods. Notably, right-sided heart failure manifestations occurring at TRF thresholds ≥20% may warrant earlier identification and tailored intervention in tricuspid valve disease.