Tricuspid E-wave velocity ≥ 100 cm/s is inaccurate for severe TR detection; a cutoff of 65 cm/s yields 55% sensitivity and 93% specificity.
Is the guideline-recommended tricuspid E-wave velocity cutoff of ≥100 cm/s a reliable marker for severe tricuspid regurgitation?
The guideline-recommended tricuspid E-wave velocity cutoff of 100 cm/s is highly specific but lacks sensitivity for severe TR, suggesting a lower cutoff of 65 cm/s may be more clinically useful.
Absolute Event Rate: 0% vs 0%
Abstract Abstract The current guidelines issued by the American Society of Echocardiography and the European Association of Cardiovascular Imaging include the presence of a dominant E wave (greater than 100 cm/s) of the tricuspid inflow, as measured by pulsed-wave Doppler, as one of the semiquantitative criteria for identifying patients with severe tricuspid regurgitation (TR). However, there is no evidence to recommend a tricuspid E wave velocity ≥ 100 cm/s as a metric of severe TR. To address this, we used PW-Doppler echocardiography to measure the tricuspid E-wave velocity in consecutive patients with at least mild TR who underwent echocardiography between December 2024 and March 2025. We enrolled 137 patients (77 ± 12 years, 85 women) with varying degrees of TR: mild (n = 39), moderate (n = 43), severe (n = 34), massive (n = 9), and torrential (n = 12). Among these patients, 62 were identified as having secondary atrial TR, 27 as secondary ventricular TR, 9 as cardiac implantable electronic device related TR, and 3 as primary TR. In 36 patients, primarily those with mild TR and normal cardiac structures, the etiology could not be categorized. The average tricuspid E-wave velocity for the entire cohort was 56 ± 17 cm/s. When broken down by severity of TR, the average tricuspid E-wave velocities were as follows: mild 47 ± 9 cm/s, moderate 50 ± 11 cm/s, severe 63 ± 15 cm/s, massive 74 ± 20 cm/s, and torrential 80 ± 23 cm/s. The distribution of the E-wave velocities across various grades of TR severity is illustrated in Figure. The tricuspid E-wave velocity showed a progressive increase as the severity of TR worsened. However, only 4 patients—2 with massive TR and 2 with torrential TR—exhibited tricuspid E-wave velocities greater than 100 cm/s. When compared to the guidelines multiparametric approach, E wave velocity demonstrated a sensitivity of 16.7%, specificity of 100%, and a Kappa concordance of 0.25, indicating poor agreement and limited ability to detect severe TR. However, the area under the curve for the tricuspid E-wave velocity demonstrated an excellent value of 0.821. A cut-off value of the tricuspid E-wave velocity set at 65 cm/s resulted in a Youden’s index of 0.509, with a sensitivity of 55% and a specificity of 93% in identifying patients with severe TR. As expected, the tricuspid E-wave velocity was more closely correlated with the regurgitant volume (r = 0.542) and the regurgitant fraction (r = 0.51) than with the effective regurgitant orifice area (r = 0.443). In patients with atrial secondary TR, the correlation between tricuspid E-wave velocity and regurgitant volume was stronger (r = 0.61) compared to those with ventricular secondary TR (r = 0.46). Conclusions While the tricuspid E-wave velocity increased with worsening TR severity, the guideline-recommended cut-off value of 100 m/s to identify severe TR is largely inaccurate. However, patients with tricuspid E-wave velocity lower than 65 cm/s have a low likelihood to have severe TR.Distribution of the E-wave velocities ROC curve of tricuspid E-wave velocity
Kawada et al. (Thu,) reported a other. Tricuspid E-wave velocity ≥ 100 cm/s is inaccurate for severe TR detection; a cutoff of 65 cm/s yields 55% sensitivity and 93% specificity.