Key result
CMR-quantified tricuspid regurgitant fraction >40% was associated with higher liver extra-cellular volume (36% vs 27% for TRF≤20%, P<0.001) and RV end-diastolic volume (117 vs 85 mL/m2, P<0.001).
Why the study?
Does CMR quantification of tricuspid regurgitant fraction associate with clinical and physiological consequences of right-sided heart failure?
Cohort (n=335)
Does CMR quantification of tricuspid regurgitant fraction associate with clinical and physiological consequences of right-sided heart failure?
Answers are grounded in this paper and cite their sources.
CMR quantification of tricuspid regurgitant fraction correlates strongly with echocardiographic severity, right ventricular remodeling, and prognostic markers, with physiological consequences evident at thresholds ≥20%.
Aims Quantitative methods for tricuspid regurgitation (TR) severity assessment are insufficiently validated. This study aims to assess cardiac magnetic resonance (CMR) quantitation of TR severity and its association with clinical and physiological consequences. Methods and Results Patients with prospective comprehensive CMR with TR assessment including regurgitant volume and fraction (TRF) were retrospectively identified. Comprehensive clinical, echocardiographic, and laboratory data were collected to assess other markers of TR severity and of TR-related heart-failure (HF), right-sided volumetric characteristics, and prognostic markers. A total of 335 patients were included presenting with a wide range of TR severity (median TRF 21[13-33]%). The number of guideline-based echocardiographic signs of severe TR were strongly associated with TRF (p<0.001). TRF was significantly associated with subjective/objective signs of right-sided HF, including biomarkers of liver dysfunction and CMR-based liver extra-cellular volume (L-ECV, 36[32-39]% for TRF>40%, 31[28-34]% for TRF 21-40% and 27[26-30]% for TRF≤20%, p<0.001). TRF was associated with maladaptive right-sided remodeling including right ventricular end-diastolic volume-indexed (RV-EDVi, 117[99-135]mL/m2 for T-RF>40%, 98[79-118]mL/m2 for TRF 21-40% and 85[73-103]mL/m2 for TRF≤20%, p<0.001). TRF was also strongly associated with prognostic markers of outcomes in TR including TAPSE/PASP ratio (0.38[0.32-0.46] for TRF>40%, 0.53[0.34-0.68] for TRF 21-40% and 0.69[0.52-0.87] for TRF≤20%, p<0.001) and the TRISCORE (5[3-7] for TRF>40%, 2[1-3] for TRF 21-40% and 1[0-2] for TRF≤20%, p<0.001). Conclusions In this all-comers TR cohort, CMR quantification of TR using TRF associated with guideline-based criteria for echocardiographic diagnosis of severe TR. RV remodeling objective right-sided HF signs/symptoms already occurred at TRF thresholds ≥20%, supporting the physiological consequences.
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Margonato et al. (2025) conducted a cohort in Tricuspid regurgitation (n=335). Cardiac magnetic resonance-derived tricuspid regurgitant fraction (TRF) vs. Lower TRF thresholds (≤20%) was evaluated on Guideline-based echocardiographic signs of severe TR (p=<0.001). CMR-quantified tricuspid regurgitant fraction >40% was associated with higher liver extra-cellular volume (36% vs 27% for TRF≤20%, P<0.001) and RV end-diastolic volume (117 vs 85 mL/m2, P<0.001).
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