Does adjusting of RVEF for tricuspid regurgitation improve prognosis of RV dysfunction in heart failure?

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 (p