Evaluation and Management Principles for Chronic Right Heart Failure and Tricuspid Regurgitation

PURPOSE OF THE REVIEW: This review provides an updated summary of the evaluation and management principles of chronic right heart failure (RHF) and tricuspid regurgitation (TR), with a focus on evolving diagnostic approaches and the role of transcatheter tricuspid valve interventions (TTVI). RECENT FINDINGS: Chronic RHF and TR frequently coexist and are associated with significant morbidity and mortality. Their interplay is both complex and bidirectional. TR leads to right ventricular (RV) volume overload, while RV remodeling in RHF promotes TR progression, primarily through annular dilatation and leaflet tethering. Advances in imaging modalities, including 3D echocardiography and cardiac magnetic resonance, have improved the evaluation of RV function and TR severity. Additionally, a refined TR grading system, now encompassing "massive" and "torrential" categories, enables more precise severity classification, which is particularly important for evaluating treatment response in device trials. Early identification of TR and RHF is crucial, and optimal management relies on understanding the underlying mechanisms, disease progression, and available treatment options. Although medical therapy for RHF and TR remains limited, TTVI offers an emerging alternative for selected patients. However, identifying appropriate candidates and the optimal timing for intervention remain key challenges. Timely diagnosis of RHF and TR, identification of the underlying causes, and comprehensive risk stratification, along with early referral to a multidisciplinary heart team, are critical for optimizing patient outcomes. Further research is needed to better define selection criteria and timing for TTVI.