Tricuspid Regurgitation Velocity Measurement and Interpretation
Normal Values and Mortality Risk
- The American Thoracic Society recommends that a normal Tricuspid Regurgitant Velocity (TRV) max is less than 2.5 m/s, with values ≥2.5 m/s considered elevated and associated with increased mortality risk 1, 2, 3
- The European Society of Cardiology states that TRV < 2.5 m/s is considered normal, while TRV 2.5-2.9 m/s is borderline elevated, associated with 4-5 fold increased mortality risk 1, 3
- The American Heart Association notes that TRV ≥ 3.0 m/s is significantly elevated, associated with 10-fold increased mortality risk 3
Clinical Context and Interpretation
- The European Society of Cardiology advises that TRV velocity alone does not indicate severity of tricuspid regurgitation, and that massive TR often presents with low jet velocity (<2 m/s) due to near equalization of right ventricular and right atrial pressures 5
- The American College of Cardiology recommends that when assessing TR severity, the continuous wave Doppler signal characteristics matter more than velocity, with mild TR characterized by a faint, parabolic signal, moderate TR by a dense, parabolic signal, and severe TR by a dense, triangular signal with early peaking 5, 6, 7
Measurement Technique Requirements
- The American Thoracic Society suggests that critical technical points to ensure accurate measurement include measuring during a stable clinical state, averaging a minimum of 5 cardiac cycles during end-expiration or quiet respiration, and using multiple transducer positions and off-axis views to align the ultrasound beam parallel to flow 1, 2, 4, 8, 9
- The European Society of Cardiology recommends that TRV is measurable in only 39-86% of patients, and that the absence of a measurable TRV does not rule out elevated pulmonary pressure 10