Corrected RVEF (cRVEF) did not provide additional prognostic value over standard 3D RVEF for predicting 2-year all-cause mortality, showing a significantly lower AUC (0.72 vs. 0.80, p=0.02).
Cohort (n=340)
Does corrected RVEF (cRVEF) improve prognostic prediction compared to standard 3D RVEF for all-cause mortality in patients hospitalized with decompensated HFrEF and HFmrEF?
In patients with decompensated HFrEF and HFmrEF, correcting 3D RVEF for tricuspid regurgitation (cRVEF) does not provide additional prognostic value over standard 3D RVEF for predicting 2-year all-cause mortality.
valor p: p=0.02
Abstract Background Three-dimensional right ventricular ejection fraction (3D RVEF) has been established as an independent prognostic parameter in patients with heart failure with reduced and mildly reduced ejection fraction (HFrEF and HFmrEF). A novel echocardiographic parameter, corrected RVEF (cRVEF), which accounts for tricuspid regurgitant volume and 3D-derived right ventricular stroke volume (RVSV) in evaluating RV systolic performance, has recently shown prognostic value in patients with tricuspid regurgitation (1,2). However, whether cRVEF offers additional prognostic information beyond standard RVEF in patients with HFrEF and HFmrEF remains to be clarified. Purpose To compare prognostic value of cRVEF and RVEF, measured by both 2D and 3D echocardiography, in patients hospitalized with decompensated HFrEF and HFmrEF, at 2-year follow-up. Methods We prospectively enrolled 340 patients (59±13 years, 80% male, LVEF 29.4±10%), hospitalized for decompensated HFrEF or HFmrEF. RV systolic function was assessed by 3D echocardiography, with RV volumes and derived RVSV and RVEF. Tricuspid regurgitant volume (TRvol) was quantified using the PISA method. Effective RV stroke volume (eRVSV) was calculated as the difference between 3D RVSV and TRvol. cRVEF was computed as: (eRVSV / end-diastolic RV volume) × 100. Mean RVEF was 38±9%, while mean cRVEF was 32±12%. TR was severe in 9.7% of patients and moderate in 20%. Primary endpoint was all-cause mortality at 2-year follow-up. Univariate and multivariate logistic regression, ROC analysis, and Kaplan-Meier survival analyses were performed. Results By univariate analysis, RVEF, cRVEF, and TRvol were all significantly associated with all-cause mortality (p0.05). ROC analysis showed that a cRVEF 25% predicted all-cause mortality with 74% sensitivity and 58% specificity. However, by comparative ROC analysis (Figure Left) RVEF had a significantly higher area under the curve than cRVEF (AUC = 0.80 vs. 0.72, p=0.02, paired-sample z-test). By multivariate (adjusted) analysis, only RVEF, but not cRVEF, remained an independent predictor of mortality. Kaplan-Meier analysis showed no significant difference in survival between patients with cRVEF 25% and those with cRVEF ≥ 25% (p=0.10), whereas survival was significantly different between patients with RVEF 30% and those with RVEF ≥ 30% (p=0.02) (Figure Right). Conclusion In patients with HFrEF and HFmrEF, cRVEF does not provide additional prognostic value over 3D RVEF in predicting all-cause mortality at 2 years. Unlike in patients with secondary tricuspid regurgitation (Clement et al, 2025), cRVEF has limited prognostic significance in this population, while RVEF remains a robust independent predictor of mortality.RVEF vs. cRVEF in HFrEF and HFmrEF
Stahie et al. (Thu,) conducted a cohort in Decompensated HFrEF and HFmrEF (n=340). Corrected RVEF (cRVEF) vs. Standard 3D RVEF was evaluated on All-cause mortality at 2-year follow-up (p=0.02). Corrected RVEF (cRVEF) did not provide additional prognostic value over standard 3D RVEF for predicting 2-year all-cause mortality, showing a significantly lower AUC (0.72 vs. 0.80, p=0.02).