Introduction: Tricuspid regurgitation (TR) is frequently present in patients admitted with acute heart failure (AHF). The aim of our study was to demonstrate if patients with AHF and severe TR on admission represent a subset of patients with higher risk. Methods: We processed the data of 50 patients with AHF. On the basis of echocardiographic findings on admission the patients were divided in two groups: (1) with severe TR (TR+, 14 men, 4 women, mean age 68.2 years), and (2) with mild/moderate TR (TR-, 23 men, 9 women, mean age 67.3 years). Using chi-square statistics we compared the clinical, prognostical and paraclinical (ECG, echocardiography, laboratory) parameters of the two groups (significant p < 0.005). Results: In the TR+ group we found a signifi cantly increased prevalence of the following parameters: important mitral regurgitation (p = 0.0206), systolic blood pressure < 120 mm Hg (p = 0.0279), major RBBB (p = 0.0352), dilated right ventricle (p = 0.0353), signs of right ventricular overload (p = 0.0158), increased left atrial size (p = 0.0101), presence of atrial fibrillation (p = 0.0154), left ventricular ejection fraction < 40% (p = 0.0223), oral anticoagulat treatment (p = 0.0006), hospital stay >10 days (p = 0.0018). We did not find significant differences regarding gender (p = 0.6478), age (p = 0.4794), right ventricular hypertrophy on ECG (p = 0.2386), high doses of loop diuretics (p = 0.639) and mortality index >15% (p = 0.2265). Conclusions: In AHF the presence of severe TR corelates well with the severity of cardiac structural alterations, especially with those of right ventricle. However, probably due to its highly dynamic feature, its prognostic value requires further clarifications.