EACVI Survey on the Current Multi-Modality Imaging Practice in Patients with Tricuspid Regurgitation
European Heart Journal - Imaging Methods and Practice, vol. 4, pp. qyag008
Abstract
Aims: This European Association of Cardiovascular Imaging (EACVI) survey evaluated current practice patterns in the imaging assessment of tricuspid regurgitation (TR), focusing on conventional and advanced modalities, the adoption of recent classifications, and barriers to quantitative right heart assessment. Methods and results: A 25-item online questionnaire was launched during EuroEcho Imaging 2024 and distributed via EACVI channels. From 10 December 2024 to 3 July 2025, 530 respondents from 69 countries participated. Most worked in tertiary/university hospitals (62%) and were imaging specialists (41%) or clinical cardiologists (40%). Transthoracic echocardiography (TTE) was almost universally applied (96%), while use of transoesophageal (TOE) and 3D echocardiography was variable. Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (RVFAC) were frequently used, but RV strain and ejection fraction were underutilized due to time constraints and software unavailability. TR quantification relied mainly on colour Doppler-based parameters, with advanced approaches-3D colour Doppler, cardiac magnetic resonance (CMR)-reserved for selected patients. Half of the respondents routinely applied the 5-grade TR severity scheme, and leaflet-based anatomical classification was inconsistently adopted. Cardiac computed tomography, CMR, and invasive haemodynamics were more often used in patients referred for transcatheter interventions. Conclusion: This EACVI survey highlights considerable heterogeneity in TR imaging practice, with increasing yet slow adoption of robust quantitative and advanced modalities for assessing TR severity and right heart morphology/function. These findings underscore the need for improved access to advanced imaging technologies and broader dissemination of contemporary standards to enhance the quality and consistency of TR imaging in clinical and research settings.
Authors 24
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Denisa Muraru corresponding
IRCCS Istituto Auxologico Italiano · University of Milano-Bicocca
Affiliation as printed
Cardiovascular Imaging Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Piazzale Brescia 20, Milan 20149 ,
Department of Medicine and Surgery, University of Milano-Bicocca , Piazza dell'Ateneo Nuovo 1, Milan 20126 ,
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St Bartholomew's Hospital · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute
Affiliation as printed
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust , West Smithfield, London EC1A 7BE ,
William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London , Charterhouse Square, London EC1M 6BQ ,
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British Heart Foundation Centre for Cardiovascular Science · University of Edinburgh
Affiliation as printed
British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh , 47 Little France Crescent, Edinburgh ,
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University of Padua · Azienda Ospedale - Università Padova
Affiliation as printed
Pediatric Cardiology Unit, Department of Women's and Children's Health, University Hospital of Padova, University of Padua , Via Giustiniani 2, Padua 35128 ,
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Carol Davila University of Medicine and Pharmacy · Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"
Affiliation as printed
Cardiothoracic Department, University of Medicine and Pharmacy ‘Carol Davila’—Euroecolab—Cardiology Department, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’ , Șos. Fundeni 258, Bucharest 022328 ,
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Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi
Affiliation as printed
Cardiology Department, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital , Turgut Özal Bulvari 11, İstasyon, Küçükçekmece, İstanbul 34303 ,
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Instituto Nacional de Cardiologia
Affiliation as printed
Echocardiography Laboratory, National Institute of Cardiology , R. das Laranjeiras, Rio de Janeiro 374 ,
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Jagiellonian University · John Paul II Hospital
Affiliation as printed
Department of Coronary Disease and Heart Failure, Jagiellonian University, Medical College , Kraków ,
Noninvasive Cardiovascular Laboratory, St. John Paul II Hospital , Prądnicka 80, Kraków 31-202 ,
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Humboldt-Universität zu Berlin · Deutsches Herzzentrum der Charité · Stiftung Charité · Charité - Universitätsmedizin Berlin
Affiliation as printed
Charite—Universitatsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Eingang A, Mittelallee 10/1.2853, Berlin 13353 ,
Department of Cardiology, Angiology and Intensive Care Medicine , Campus Charité Mitte, Deutsches Herzzentrum der Charité, Charitépl. 1, Berlin 10117 ,
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Royal United Hospital · Royal United Hospital Bath NHS Trust · University of Bath
Affiliation as printed
Department for Health, University of Bath , Claverton Down, Bath BA2 7AY ,
Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust , Combe Park, Avon, Bath BA1 3NG ,
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Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Affiliation as printed
Department of Cardiothoracic and Vascular Anesthesia and Cardiothoracic and Vascular Intensive Care Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda , Piazza dell'Ospedale Maggiore, 3, Milan 20162 ,
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Ziekenhuis Oost-Limburg · Hasselt University
Affiliation as printed
Department of Cardiology, Ziekenhuis Oost-Limburg , Synaps Park 1, Genk 3600 ,
Faculty of Medicine and Life Sciences, Hasselt University , Agoralaan gebouw D, Diepenbeek 3590 ,
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Affiliation as printed
Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa , Via Roma, 55/Edificio 57, Pisa 56126 ,
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King's College London · Harefield Hospital
Affiliation as printed
Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals , Hill End Road, Harefield UB69 6JH ,
School of Cardiovascular, Metabolic Medicine and Sciences, King’s College London , London, London WC2R 2LS ,
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IRCCS Istituto Auxologico Italiano
Affiliation as printed
Cardiovascular Imaging Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Piazzale Brescia 20, Milan 20149 ,
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Affiliation as printed
Department of Cardiology, University of Leipzig , Liebigstraße 18, Leipzig 04103 ,
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Affiliation as printed
Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute , Via Olgettina, 60, Milan 20132 ,
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Carol Davila University of Medicine and Pharmacy · Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"
Affiliation as printed
Cardiothoracic Department, University of Medicine and Pharmacy ‘Carol Davila’—Euroecolab—Cardiology Department, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’ , Șos. Fundeni 258, Bucharest 022328 ,
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Vrije Universiteit Brussel · Universitair Ziekenhuis Brussel
Affiliation as printed
Cardiology, Centrum voor hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB) , 101 laarbeeklaan, Brussels 1090 ,
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Albinusdreef 2, Leiden 2300 RC ,
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Cliniques Universitaires Saint-Luc · UCLouvain
Affiliation as printed
CARD Unit, Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain , Av. Hippocrate 10, Brussels 1200 ,
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Woluwe , St. Lambert ,
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University of Padua · Azienda Ospedale - Università Padova
Affiliation as printed
Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital and University of Padua , Via Nicolò Giustiniani, 2, Padua 35128 ,
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Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol · Hospital Universitari Germans Trias i Pujol
Affiliation as printed
Centre of Comparative Medicine and Bioimaging, Research Institute Germans Trias i Pujol , Badalona 08916 ,
Department of Cardiology, Heart Institute, Hospital University Germans Trias i Pujol , Badalona ,
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IRCCS Istituto Auxologico Italiano · University of Milano-Bicocca
Affiliation as printed
Cardiovascular Imaging Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS , Piazzale Brescia 20, Milan 20149 ,
Department of Medicine and Surgery, University of Milano-Bicocca , Piazza dell'Ateneo Nuovo 1, Milan 20126 ,
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