{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T05:22:33Z","timestamp":1793251353322,"version":"4.5.0"},"reference-count":94,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Right heart failure (HF) and tricuspid regurgitation (TR) are closely interrelated conditions, linked by a bidirectional and self-perpetuating pathophysiological relationship. Alterations in right-ventricular (RV) loading conditions, pulmonary vascular impedance, and ventriculo-arterial (VA) coupling play a central role in the development and progression of TR, which in turn exacerbates RV volume overload and end-organ dysfunction. Methods: This review provides a comprehensive overview of the pathophysiology of right HF and TR, focusing on the mechanisms underlying RV dysfunction, pressure\u2013volume (PV) relationships, and pulmonary vascular load. We further examine the clinical implications of this interaction and summarize current strategies for risk stratification, with particular emphasis on disease-specific risk models. Results: TR emerges both as a consequence and a driver of RHF. Conditions such as pulmonary hypertension (PH) and left-sided heart disease promote annular dilation and leaflet tethering, leading to functional TR. Conversely, TR increases RV volume overload, worsening chamber dilation, reducing effective forward stroke volume (SV), and accelerating disease progression. This vicious cycle results in progressive RV impairment, impaired left-ventricular filling through ventricular interdependence, and systemic venous congestion affecting renal and hepatic function. Traditional risk scores fail to capture this complex pathophysiology. In this context, TRISCORE integrates clinical, biological, and echocardiographic (TTE) parameters reflecting RV dysfunction and systemic involvement, providing a more comprehensive assessment of disease severity and prognosis. Conclusions: TR should be considered not only a marker but also a key determinant of right HF progression. A multiparametric approach integrating pathophysiology and disease-specific risk stratification is essential to identifying the optimal therapeutic window and guiding clinical decision making.<\/jats:p>","DOI":"10.3390\/jcm15103622","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T19:10:52Z","timestamp":1778267452000},"page":"3622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Tricuspid Regurgitation: Pathophysiology, Risk Stratification, and Implications for Intervention"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2935-2023","authenticated-orcid":false,"given":"Mariagrazia","family":"Piscione","sequence":"first","affiliation":[{"name":"Asl 2 Abruzzo, Santissima Annunziata Hospital, 66100 Chieti, Italy"},{"name":"Renzetti Hospital, 66034 Lanciano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7359-4028","authenticated-orcid":false,"given":"Barbara","family":"Pala","sequence":"additional","affiliation":[{"name":"PhD School of Applied Medical-Surgical Sciences, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy"},{"name":"UOC Cardiologia Ospedale IDI\u2014IRCCS, 00167 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Gaudio","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Campus Bio-Medico, University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-4276","authenticated-orcid":false,"given":"Paola","family":"Gualtieri","sequence":"additional","affiliation":[{"name":"Section of Food Science, Clinical Nutrition and Pharmaceutical Sciences, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6094-6330","authenticated-orcid":false,"given":"Mario","family":"Laudazi","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Diagnostic Imaging Division, Tor Vergata University of Rome, Via Cracovia 50, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2280-6757","authenticated-orcid":false,"given":"Simone","family":"Steffani","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Diagnostic Imaging Division, Tor Vergata University of Rome, Via Cracovia 50, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-4166","authenticated-orcid":false,"given":"Marcello","family":"Chiocchi","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Diagnostic Imaging Division, Tor Vergata University of Rome, Via Cracovia 50, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-5065","authenticated-orcid":false,"given":"Ferdinando","family":"Iellamo","sequence":"additional","affiliation":[{"name":"Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Giuseppe","family":"Garaci","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Diagnostic Imaging Division, Tor Vergata University of Rome, Via Cracovia 50, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-2621","authenticated-orcid":false,"given":"Marco Alfonso","family":"Perrone","sequence":"additional","affiliation":[{"name":"Division of Cardiology and CardioLab, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-6723","authenticated-orcid":false,"given":"Laura","family":"Di Renzo","sequence":"additional","affiliation":[{"name":"Section of Food Science, Clinical Nutrition and Pharmaceutical Sciences, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e032999","DOI":"10.1161\/JAHA.123.032999","article-title":"Tricuspid Regurgitation: A Review of Current Interventional Management","volume":"6","author":"Ambrosino","year":"2024","journal-title":"J. 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