Association With Outcome of the Regurgitant-Volume Adjusted Right Ventricular Ejection Fraction in Secondary Tricuspid Regurgitation

Background: In patients with secondary tricuspid regurgitation (STR), right ventricular ejection fraction (RVEF) may not accurately reflect the actual RV systolic performance since a considerable amount of the RV stroke volume (SV) is regurgitated back into the right atrium. To overcome this limitation, we explored the association with the outcome of the effective RVEF (eRVEF), which accounts for the tricuspid regurgitant volume (RegVol). Methods: Five hundred thirteen patients with STR (mean age 75 ± 13 years, 39% atrial STR, 58% severe) underwent complete two-, three-dimensional, and Doppler echocardiography. The eRVEF was computed as RV forward SV/RV end-diastolic volume, where forward SV was obtained by subtracting the tricuspid RegVol from the total RVSV. The end point was a composite of all-cause death and heart failure hospitalization. Results: After a mean follow-up of 18 ± 15 months, 195 patients (38%) reached the composite end point. At time-dependent receiver operating chara...