Liver Extracellular Volume in Patients With Tricuspid Regurgitation: A Novel Prognostic Marker

Liver extracellular volume (L-ECV), a novel cardiac magnetic resonance (CMR) parameter of systemic venous congestion, might help to stratify tricuspid regurgitation (TR) patients at higher risk, but its role in this context is unexplored.

The aim of this study was to assess the incremental prognostic relevance of L-ECV in a large TR cohort.

Data were collected from patients with TR referred to CMR between 2019 and 2024 who had parametric mapping analysis for L-ECV quantification. The primary endpoint was the composite of all-cause mortality and heart failure (HF) hospitalization, under medical management.

In 462 patients included (median age: 67 years; 43% female), median left ventricular ejection fraction was 51% (Q1-Q3: 40%-59%), median tricuspid regurgitant fraction was 21% (Q1-Q3: 14%-33%), and median L-ECV was 31% (Q1-Q3: 28%-35%). When dividing the cohort according to median L-ECV value, patients with high L-ECV (≥ median) showed worse baseline status with more clinical and imaging signs of right HF and (after a median follow-up of 2.1 years) poorer survival free from the primary outcome (P < 0.001) compared with patients with low L-ECV. High L-ECV independently predicted the outcome even after multivariable adjustment accounting for TR severity, biventricular ejection fraction, and pulmonary pressure (adjusted HR: 1.82; 95% CI: 1.03-3.18; P = 0.030). Finally, L-ECV showed incremental prognostic value compared with TRI-SCORE when assessed in a nested Cox model.

In our large real-world TR cohort, L-ECV appeared as a novel, powerful CMR marker of right HF with an independent and incremental prognostic value to stratify patients with TR at higher risk of events.