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Valvular & structural heart diseaseCohort study

Prognostic Implications of RV-Arterial Coupling Estimated by CMR in a Large Cohort of Tricuspid Regurgitation Patients

Circ Cardiovasc ImagingPublished

  • cohort
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Authors' conclusion

In this large cohort of patients with a wide spectrum of TR severity, right ventricular-pulmonary arterial coupling assessed by cardiac magnetic resonance was strongly associated with right-sided heart failure and worse long-term prognosis, even after comprehensive adjustment.

Study context

Population
Patients referred for cardiac magnetic resonance from 2019 to 2024 who had tricuspid regurgitation (TR) quantification, with a spectrum of TR severity, under medical managementpatients included
Participants
631 patients
Exposure
Low vs higher forward right ventricular stroke volume (f-RVSV)/end-systolic volume (ESV) ratio

Main finding

As reported in the abstract

Baseline characteristics
median age
66 (interquartile range [IQR], 54-75) years
median tricuspid regurgitant volume
18 (IQR, 12-30 mL)
median left ventricular ejection fraction
53 (IQR, 41-61)%
median RV ejection fraction
53 (IQR, 45-58)%
median f-RVSV/ESV ratio
0.82 (IQR, 0.58-1.11)

Observational data: associations, not effects.

Further findings

Composite of all-cause death and heart failure hospitalization

Comparisonadjusted hazard ratio (95% CI)P value
f-RVSV/ESV ≤0.572.36 (1.27–4.37)P = 0.004
  • Composite of all-cause death and heart failure hospitalization: after comprehensive adjustment for clinical and imaging confounders

f-RVSV/ESV ratio cutoff associated with a hazard >1 for the composite outcome (restricted spline curve analysis)

cutoff
≤0.57

Signs of right heart failure, TRI-SCORE and right-sided chamber remodeling at baseline

low f-RVSV/ESV ratio strongly associated with subjective and objective signs of right heart failure, higher TRI-SCORE, and worse right-sided chamber remodeling
all P <0.001

Survival · median follow-up of 1.8 years (IQR, 1.5-2.0)

patients with a low f-RVSV/ESV ratio showed worse survival
P < 0.001

Long-term prognosis by TR severity

low f-RVSV/ESV worse prognosis, mild TR
P < 0.001
low f-RVSV/ESV worse prognosis, moderate TR
P < 0.001
low f-RVSV/ESV worse prognosis, severe TR
P = 0.018

Original publication

Prognostic Implications of RV-Arterial Coupling Estimated by CMR in a Large Cohort of Tricuspid Regurgitation Patients. Circ Cardiovasc Imaging. Published 25 June 2026. doi:10.1161/circimaging.126.019717
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Summarised from the published abstract; every number is checked against it