Redefining Right Ventricular Function: Incremental Prognostic Utility of Effective RVEF on CMR in Functional Tricuspid Regurgitation-A Multicenter Validation Study

doi:10.1016/j.jcmg.2026.02.018

Valvular & structural heart disease

Redefining Right Ventricular Function: Incremental Prognostic Utility of Effective Right Ventricular Ejection Fraction (RVEF) on Cardiac Magnetic Resonance (CMR) in Functional Tricuspid Regurgitation-A Multicenter Validation Study

JACC Cardiovasc ImagingPublished 16 Apr 2026Cohort study with external validation

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Authors' conclusion

eRVEF independently predicts mortality in TR and provides incremental prognostic value over conventional prognostic markers.

Study context

Population: Consecutive patients with at least moderate functional tricuspid regurgitation (TR) (regurgitant fraction ≥30% or volume ≥30 mL) on CMRderivation
Participants: 453 patients

Comparison: Impaired vs preserved effective RVEF
Outcome: All-cause mortality
Follow-up: Median 2.7 years

Methodological detailsderivation cohort, 2 independent external validation cohorts

Derivation cohort
2 independent external validation cohorts

Performance

As reported in the abstract

All-cause mortality · median 2.7 years (Q1-Q3: 0.6-6.6 years)

Impaired eRVEF28%

Preserved eRVEF12%

Each group vs preserved eRVEFHazard ratio (95% CI)P value

Impaired eRVEF

1.72(1.16–2.54)

P = 0.007

eRVEFadjusted for age, RV size, TR severity, conventional RVEF, right-sided congestion

0.49(0.24–0.97)

P = 0.042

Overall mortality: 20%

Further findings

All-cause mortality, adjusted for known TR risk markers (age, RV size, TR severity, conventional RVEF, right-sided congestion)

Effective right ventricular ejection fraction (eRVEF) remained independently predictive of mortality: HR: 0.49 [95% CI: 0.24-0.97]; P = 0.042

All-cause mortality, external validation in 2 independent cohorts (n = 316)

eRVEF ≤25% prognostic in both cohorts: HR: 2.66-2.86; both P < 0.05

Incremental mortality prediction (model chi-square)

Adding eRVEF to a model with RVEF improved prediction: chi-square from 30.6 to 37.0; P = 0.011
Adding RVEF to eRVEF did not improve prediction: chi-square from 35.4 to 37.0; P = 0.199

Original publication

Redefining Right Ventricular Function: Incremental Prognostic Utility of Effective RVEF on CMR in Functional Tricuspid Regurgitation-A Multicenter Validation Study. JACC Cardiovasc Imaging. Published 16 April 2026. doi:10.1016/j.jcmg.2026.02.018

Read the original article ↗PubMed

Summarised from the published abstract; every number is checked against it