ACC CardiaCast Heart Vision: Imaging and the 2025 ACC Pathway for Tricuspid Regurgitation
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Nov 14, 2025 Dr. Rebecca T. Hahn, a prominent figure in valvular heart disease and advanced cardiovascular imaging, joins Dr. Purvi Parwani to discuss the 2025 ACC expert consensus on tricuspid regurgitation. They delve into the crucial role of multimodality imaging in evaluating and managing this condition. Dr. Hahn emphasizes the importance of early diagnosis, the limitations of traditional echocardiographic methods, and the preference for advanced quantification techniques. Their conversation also highlights a shift in clinical mindset toward better patient care.
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Decade Of Rapid TR Progress
- Rapid progress since the first transcatheter tricuspid repair a decade ago has transformed TR care.
- The 2025 ACC decision pathway fills a gap between evolving evidence and existing guidelines.
Assess The Whole Right Heart
- Assess TR by etiology, chamber response, preload, afterload, and right heart function, not just the valve.
- Use IVC size, RA strain, pulmonary pressures, and comprehensive RV evaluation to guide severity assessment.
Prefer 3D Vena Contracta Over PISA
- Avoid relying on color jet area or PISA alone because they underestimate TR severity, often >50%.
- Prefer 3D vena contracta area or volumetric/Doppler stroke volume methods for quantitative TR assessment.