Peugnet F, Bohbot Y, Chadha G, et al. - Given that some patients present with “more than severe” tricuspid regurgitation (TR), therefore, researchers investigated the prognosis of these very severe TR patients. A coaptation gap≥10mm, a laminar TR flow and a systolic reversal of the hepatic vein flow were the 3 simple echocardiographic parameters that were used to define very severe TR. This study involved 259 consecutive patients with moderate-to-severe TR (n = 114) and severe TR (n = 145). The integration of hospitalisation for right heart failure and cardiovascular death was the primary endpoint. A median follow-up of 24(7 to 47) months was performed. The definition of very severe TR was met by 52 (36%) of the patients with severe TR. Overall, very severe TR was commonly found in patients with severe TR, corresponded to a more advanced stage of the disease and was shown to be related to poor results. Thus, it is justified to apply a 5-grade classification of TR severity in routine clinical practice.