Cardiac MRI Measure Improves Risk Prediction in Tricuspid Regurgitation

Tricuspid regurgitation, in which blood flows back from the right ventricle into the right atrium, can lead to progressive right-sided heart failure. Clinicians need reliable ways to gauge severity and decide when to intervene. Conventional right ventricular ejection fraction often appears preserved despite significant backflow, delaying recognition of risk. To help address this challenge, investigators have developed an MRI-based measurement that may strengthen risk assessment in tricuspid regurgitation.

Developed and evaluated by teams at Weill Cornell Medicine and NewYork-Presbyterian, effective right ventricular ejection fraction (eRVEF) is derived from cardiac magnetic resonance imaging (MRI). The measure estimates the volume of blood actually ejected from the right ventricle to the lungs. It is designed to reflect both right ventricular performance and the hemodynamic burden of tricuspid regurgitation.

The study analyzed deidentified clinical and cardiac imaging data from nearly 800 patients with at least moderate tricuspid regurgitation. The initial cohort included 453 patients from NewYork-Presbyterian/Weill Cornell Medical Center, with external validation in 239 patients at Houston Methodist DeBakey Heart and Vascular Center and 77 patients at Duke University Medical Center. Impaired eRVEF, defined as less than 25% of right ventricle–filled volume, identified patients with markedly higher risks of adverse outcomes over several years, including progression of regurgitation and mortality.

Investigators compared eRVEF with conventional right ventricular ejection fraction (RVEF). Adding eRVEF to a prediction model that already included RVEF significantly improved mortality prediction, whereas adding RVEF to a model that already included eRVEF did not. In patients with at least moderate tricuspid regurgitation, these findings indicate that eRVEF is more informative than RVEF for assessing right-sided cardiac function.

The work was published in JACC: Cardiovascular Imaging. The teams plan forward-looking studies to determine whether using eRVEF to select candidates and time interventions can improve outcomes. They also aim to evaluate eRVEF as a marker of treatment response and as a potential endpoint for therapeutic studies.

“This investigation highlights the expanding role of cardiac MRI in the assessment of patients with valvular heart disease. Its unique ability to precisely quantify valvular heart lesions and the associated cardiac remodeling in both the left and right heart makes it an indispensable tool for comprehensive clinical evaluation,” said Dr. Dipan Shah, professor of cardiology at Houston Methodist Research Institute and professor of medicine at Weill Cornell Medicine.

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