重新定义右心室功能：功能性三尖瓣反流中CMR有效RVEF的增量预后价值—多中心验证研究
本研究在453例至少中度功能性三尖瓣反流的患者中，基于CMR计算有效右心室射血分数（eRVEF=前向每搏量/右室舒张末期容积），以全因死亡为终点推导出eRVEF≤25%的阈值。eRVEF受损与更差的双心室重构和功能相关，且独立预测死亡，在常规RVEF基础上提供增量预后价值，并在2个外部队列（共316例）中得到验证。
要点
- 在功能性三尖瓣反流中，eRVEF≤25%独立预测全因死亡，优于常规RVEF。
- eRVEF受损与更严重的双心室重构、更差的双心室功能及更多延迟钆增强相关。
- 将eRVEF加入含RVEF的模型可改善死亡预测，反之则不然。
核心结论
- eRVEF独立预测三尖瓣反流患者的全因死亡，并在常规预后标志物基础上提供增量预后价值。
研究设计与样本
- 推导队列为453例连续的功能性三尖瓣反流患者（反流分数≥30%或反流量≥30 mL），接受心脏磁共振检查。
- eRVEF计算为前向容积与右室舒张末期容积的比值，阈值≤25%基于全因死亡数据推导。
- 外部验证在2个独立队列共316例患者中进行，采用相同纳入标准。
关键影像表现/征象
- eRVEF受损与更严重的双心室重构、更差的双心室功能及更大的延迟钆增强负荷相关（P均<0.05）。
- eRVEF受损者三尖瓣反流容积和反流分数更高（P均<0.05）。
诊断标准与关键数值
- eRVEF阈值≤25%用于定义右室功能受损，基于全因死亡数据推导。
- 推导队列中，eRVEF受损者死亡率28%，保留者12%（HR 1.72，95%CI 1.16-2.54，P=0.007）。
- 多变量调整后eRVEF仍独立预测死亡（HR 0.49，95%CI 0.24-0.97，P=0.042）。
- 将eRVEF加入含RVEF的模型，卡方从30.6升至37.0（P=0.011）。
- 外部验证中eRVEF≤25%的预后意义得到确认（HR 2.66-2.86，P均<0.05）。
临床应用与阅片要点
- 在功能性三尖瓣反流患者中，除常规RVEF外应计算eRVEF（前向容积/右室舒张末期容积），以识别高危患者。
- eRVEF≤25%提示预后不良，可辅助临床决策和风险分层。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Right ventricular ejection fraction (RVEF) is a known predictor of adverse outcomes; however, its prognostic value diminishes in tricuspid regurgitation (TR).
OBJECTIVES: This study aims to assess whether effective right ventricular ejection fraction (eRVEF) offers a more physiologic assessment of RV function and improves risk stratification in patients with TR.
METHODS: The derivation cohort comprised 453 consecutive patients with at least moderate functional TR (regurgitant fraction ≥30% or volume ≥30 mL) on cardiac magnetic resonance (CMR). eRVEF was calculated as the ratio of forward volume to RV end-diastolic volume. The eRVEF threshold (≤25%) was derived based on all-cause mortality data. Clinical data were collected from standardized questionnaires at the time of CMR and supplemented with electronic health records; the primary outcome was all-cause mortality. External validation was performed in 2 independent cohorts, totaling 316 patients using identical inclusion criteria.
RESULTS: In the derivation cohort, impaired eRVEF was associated with more advanced biventricular remodeling, worse biventricular function, and greater burden of late gadolinium enhancement (P < 0.05 for all), which was paralleled by higher TR volume and fraction (both P < 0.05). Over a median follow-up period of 2.7 years (Q1-Q3: 0.6-6.6 years), 20% of the patients died; mortality was higher in patients with impaired versus preserved eRVEF (28% vs 12%; HR: 1.72 [95% CI: 1.16-2.54]; P = 0.007). After adjusting for known TR risk markers including age, RV size, TR severity, conventional RVEF, and clinical markers of right-sided congestion, eRVEF remained independently predictive of mortality (HR: 0.49 [95% CI: 0.24-0.97]; P = 0.042). Adding eRVEF to a model inclusive of RVEF improved mortality prediction (chi-square from 30.6 to 37.0; P = 0.011) whereas adding RVEF to eRVEF did not (chi-square from 35.4 to 37.0; P = 0.199). External validation confirmed the prognostic significance of eRVEF ≤25% in both cohorts (HR: 2.66-2.86; both P < 0.05).
CONCLUSIONS: eRVEF independently predicts mortality in TR and provides incremental prognostic value over conventional prognostic markers.
引用
- Zhang RS, Villar-Calle P, Chevalier C, et al. Redefining Right Ventricular Function: Incremental Prognostic Utility of Effective RVEF on CMR in Functional Tricuspid Regurgitation-A Multicenter Validation Study. JACC Cardiovasc Imaging. 2026. PMID: 41995650. doi:10.1016/j.jcmg.2026.02.018
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。