Impact of right ventricular systolic function in patients with significant tricuspid regurgitation. A cardiac magnetic resonance study

• Published in: International journal of cardiology Vol. 339; pp. 120 - 127
• Main Authors: Hinojar, Rocio, Gómez, Ariana González, García-Martin, Ana, Monteagudo, Juan Manuel, Fernández-Méndez, Mª. Angeles, de Vicente, Ana Garcia, Salinas, Gonzalo Luis Alonso, Zamorano, Jose Luis, Fernández-Golfín, Covadonga
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 15.09.2021
• Subjects: EF; TV; RVEF; SV; RV; TTE; CMR; ESV; TRF; LV; RVS; BSA; EDV; TRV; TR; eRVEF
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.07.023

Right ventricle (RV) dilatation and dysfunction are established criteria for intervention in severe tricuspid regurgitation (TR); however thresholds to support intervention are lacking. New measures of RV function such as RV shortening (RVS) and effective RV ejection fraction (eRVEF) may be earlier markers of RV dysfunction. to compare the prognostic impact of different parameters of RV function and to describe cut-off values of RV size/function and TR severity of poor prognosis. Consecutive patients evaluated in the Heart Valve Clinic with significant TR (severe, massive or torrential TR) undergoing a CMR study were included. In addition to parameters of biventricular volume and function, RVS and eRVEF were assessed. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined. 75 patients were included (age 75 ± 8 years, female 75%). During a median follow-up of 3 years (IQR: 1.4–3.9 years), 39% experienced the endpoint. Cut-off values of worse prognosis were: RVS ≥ −14%, eRVEF ≤34%, RVEF ≤58%, RV-EDV ≥100 ml/m2, TR regurgitant fraction (TRF) ≥40% and TR volume ≥ 42 ml. RVS and eRVEF identified higher rates of RV dysfunction than RVEF. After adjustment for age and LVEF, both eRVEF ≤34% (HR: 5.29 [2.25–12.4]) and RVS ≥ −14% (HR: 3.46 [1.13–9.17]) were significantly associated with outcomes. Among all parameters of RV function, eRVEF was the strongest predictor of outcomes, incremental to RVEF (ΔC-statistic 0.139 [0.040–0.237], p = 0.005). Patients with eRVEF ≤34% and RV-EDV ≥100 ml/m2 or eRVEF ≤34% and TRF ≥40% had the worst prognosis (p < 0.01 for both). RVS and eRVEF identify higher rates of RV dysfunction beyond RVEF. Among all measures, eRVEF held the strongest association with outcomes, incremental to RVEF. •Accurate assessment of RV size and systolic function is determinant in patients with severe tricuspid regurgitation (TR).•For the moment RV thresholds of poor outcomes to support intervention are lacking. · While RVEF by CMR remain the gold standard, it can overestimate RV function in severe TR.•RV shortening and effective RVEF can be easily calculated in conventional studies without additional sequences or dedicated software’s.•Both parameters detect higher rates of RV dysfunction. Among all, eRVEF has the strongest association with outcomes, incremental to RVEF.