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Related Concept Videos

Mitral Regurgitation II: Clinical Features and Diagnostic Tests01:23

Mitral Regurgitation II: Clinical Features and Diagnostic Tests

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Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...
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Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

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Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
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Redefining Right Ventricular Function: Incremental Prognostic Utility of Effective RVEF on CMR in Functional

Robert S Zhang1, Pablo Villar-Calle1, Céleste Chevalier2

  • 1New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.

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Summary

Effective right ventricular ejection fraction (eRVEF) better predicts mortality in tricuspid regurgitation (TR) patients than standard RVEF. This new metric improves risk stratification and identifies patients needing closer monitoring for adverse outcomes.

Keywords:
ejection fractionmagnetic resonance imagingright ventricletricuspid regurgitation

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Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Pulmonary Hypertension

Background:

  • Right ventricular ejection fraction (RVEF) predicts outcomes but is less reliable in tricuspid regurgitation (TR).
  • Tricuspid regurgitation poses challenges for accurate RV function assessment.
  • Novel metrics are needed for improved risk stratification in TR patients.

Purpose of the Study:

  • To evaluate effective right ventricular ejection fraction (eRVEF) for RV function assessment in TR.
  • To determine if eRVEF improves risk stratification compared to conventional RVEF.
  • To assess the prognostic value of eRVEF in patients with moderate to severe functional TR.

Main Methods:

  • Cardiac magnetic resonance (CMR) was used to assess 453 patients with moderate to severe functional TR.
  • Effective right ventricular ejection fraction (eRVEF) calculated as forward volume/RV end-diastolic volume.
  • External validation in two independent cohorts (316 patients) using all-cause mortality as the primary outcome.

Main Results:

  • Impaired eRVEF correlated with advanced biventricular remodeling and dysfunction.
  • Mortality was significantly higher in patients with impaired eRVEF (28% vs 12%).
  • eRVEF independently predicted mortality and improved risk prediction models beyond conventional markers.

Conclusions:

  • Effective right ventricular ejection fraction (eRVEF) is an independent predictor of mortality in TR.
  • eRVEF offers incremental prognostic value over traditional markers like RVEF.
  • eRVEF provides a more accurate assessment of RV function and patient risk in TR.