Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation
Background: Tricuspid regurgitation (TR) is associated with right ventricular (RV) remodeling; however, conventional RV metrics may not fully reflect the interplay between the right and left ventricles. Objectives: The aim of the study was to examine the prognostic value of the right ventricular-to-...
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Elsevier
2025-08-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25003424 |
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| author | Robert S. Zhang, MD Pablo Villar-Calle, MD Lily Jin, BS Rachel Axman, MD Zachary Falk, MD Mahniz Reza, BA Annie Tsay, MD, MPH Giorgia Falco, MD Andre Cheng, MD Shmuel Chen, MD, PhD Jonathan W. Weinsaft, MD Jiwon Kim, MD |
| author_facet | Robert S. Zhang, MD Pablo Villar-Calle, MD Lily Jin, BS Rachel Axman, MD Zachary Falk, MD Mahniz Reza, BA Annie Tsay, MD, MPH Giorgia Falco, MD Andre Cheng, MD Shmuel Chen, MD, PhD Jonathan W. Weinsaft, MD Jiwon Kim, MD |
| author_sort | Robert S. Zhang, MD |
| collection | DOAJ |
| description | Background: Tricuspid regurgitation (TR) is associated with right ventricular (RV) remodeling; however, conventional RV metrics may not fully reflect the interplay between the right and left ventricles. Objectives: The aim of the study was to examine the prognostic value of the right ventricular-to-left ventricular volume ratio (RV/LVvol) ratio in TR. Methods: A retrospective analysis was conducted on 949 patients with ≥moderate TR who underwent cardiac magnetic resonance imaging between 2005 and 2024. The RV/LVvol ratio was assessed as a dichotomous variable (normal: <1.27, abnormal: ≥1.27) and by severity strata. Follow-up data, including all-cause mortality, were collected using the Social Security Death Index and electronic medical records. Results: Of the 949 patients, 43.6% had an abnormal RV/LVvol ratio. Among 528 patients with a normal RV end-diastolic volume index, 178 (33.7%) had an abnormal RV/LVvol ratio. Over a mean follow-up of 4.8 ± 4.5 years, 236 patients died. An abnormal RV/LVvol ratio was independently associated with increased mortality after adjusting for covariates (adjusted HR: 1.47, 95% CI: 1.01 to 2.14, P = 0.043). Mortality risk increased with RV/LVvol ratio severity, with severe ratios conferring the highest risk (adjusted HR: 2.20, 95% CI: 1.31-4.76, P = 0.045). The RV/LVvol ratio provided significant incremental prognostic value over conventional RV indices, improving global chi-square from 24.7 (age/sex) to 47.1 with RV ejection fraction, 59.3 with RV end-diastolic volume index, and 68.3 with the addition of RV/LVvol ratio (P = 0.005). Conclusions: The RV/LVvol ratio is a strong predictor of mortality in advanced TR, capturing ventricular remodeling not identified by conventional metrics. |
| format | Article |
| id | doaj-art-b82b85d930044e5eafb44c2e1fe3e980 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | JACC: Advances |
| spelling | doaj-art-b82b85d930044e5eafb44c2e1fe3e9802025-08-20T03:30:14ZengElsevierJACC: Advances2772-963X2025-08-014810192210.1016/j.jacadv.2025.101922Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid RegurgitationRobert S. Zhang, MD0Pablo Villar-Calle, MD1Lily Jin, BS2Rachel Axman, MD3Zachary Falk, MD4Mahniz Reza, BA5Annie Tsay, MD, MPH6Giorgia Falco, MD7Andre Cheng, MD8Shmuel Chen, MD, PhD9Jonathan W. Weinsaft, MD10Jiwon Kim, MD11Division of Cardiology, Weill Cornell Medicine, New York, New York, USA; Address for correspondence: Dr Robert S. Zhang, Instructor in Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, Starr-4, New York, New York 10021, USA.Division of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADepartment of Medicine, Weill Cornell Medicine, New York, New York, USADepartment of Medicine, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USADivision of Cardiology, Weill Cornell Medicine, New York, New York, USABackground: Tricuspid regurgitation (TR) is associated with right ventricular (RV) remodeling; however, conventional RV metrics may not fully reflect the interplay between the right and left ventricles. Objectives: The aim of the study was to examine the prognostic value of the right ventricular-to-left ventricular volume ratio (RV/LVvol) ratio in TR. Methods: A retrospective analysis was conducted on 949 patients with ≥moderate TR who underwent cardiac magnetic resonance imaging between 2005 and 2024. The RV/LVvol ratio was assessed as a dichotomous variable (normal: <1.27, abnormal: ≥1.27) and by severity strata. Follow-up data, including all-cause mortality, were collected using the Social Security Death Index and electronic medical records. Results: Of the 949 patients, 43.6% had an abnormal RV/LVvol ratio. Among 528 patients with a normal RV end-diastolic volume index, 178 (33.7%) had an abnormal RV/LVvol ratio. Over a mean follow-up of 4.8 ± 4.5 years, 236 patients died. An abnormal RV/LVvol ratio was independently associated with increased mortality after adjusting for covariates (adjusted HR: 1.47, 95% CI: 1.01 to 2.14, P = 0.043). Mortality risk increased with RV/LVvol ratio severity, with severe ratios conferring the highest risk (adjusted HR: 2.20, 95% CI: 1.31-4.76, P = 0.045). The RV/LVvol ratio provided significant incremental prognostic value over conventional RV indices, improving global chi-square from 24.7 (age/sex) to 47.1 with RV ejection fraction, 59.3 with RV end-diastolic volume index, and 68.3 with the addition of RV/LVvol ratio (P = 0.005). Conclusions: The RV/LVvol ratio is a strong predictor of mortality in advanced TR, capturing ventricular remodeling not identified by conventional metrics.http://www.sciencedirect.com/science/article/pii/S2772963X25003424magnetic resonance imagingremodelingright ventricletricuspid regurgitation |
| spellingShingle | Robert S. Zhang, MD Pablo Villar-Calle, MD Lily Jin, BS Rachel Axman, MD Zachary Falk, MD Mahniz Reza, BA Annie Tsay, MD, MPH Giorgia Falco, MD Andre Cheng, MD Shmuel Chen, MD, PhD Jonathan W. Weinsaft, MD Jiwon Kim, MD Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation JACC: Advances magnetic resonance imaging remodeling right ventricle tricuspid regurgitation |
| title | Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation |
| title_full | Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation |
| title_fullStr | Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation |
| title_full_unstemmed | Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation |
| title_short | Prognostic Value of the Right Ventricular-to-Left Ventricular Volume Ratio in Tricuspid Regurgitation |
| title_sort | prognostic value of the right ventricular to left ventricular volume ratio in tricuspid regurgitation |
| topic | magnetic resonance imaging remodeling right ventricle tricuspid regurgitation |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25003424 |
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