A new cardiac magnetic resonance imaging-based measurement may improve how physicians assess a common heart valve condition, according to a study led by Weill Cornell Medicine and NewYork-Presbyterian investigators. The findings support the broader use and further study of the new metric known as effective right ventricular ejection fraction (eRVEF).
In the study , published April 17 in the journal JACC: Cardiovascular Imaging , the researchers analyzed deidentified clinical and cardiac imaging data, on nearly 800 patients who had the heart valve condition called tricuspid regurgitation. They found that eRVEF predicted mortality risk better than traditional risk markers for the disorder.
“Our goal in tricuspid regurgitation is to detect disease progression and intervene before irreversible heart dysfunction develops,” said study corresponding and co-senior author Dr. Jiwon Kim , associate professor of medicine in the Division of Cardiology and director of the Cardiovascular Imaging Program at Weill Cornell Medicine and a cardiologist at New York-Presbyterian/Weill Cornell Medical Center. “We believe this new measurement could help cardiologists identify high-risk patients earlier and make more informed treatment decisions.”
The tricuspid valve regulates the flow between the heart’s right atrium, which receives low-oxygen blood from major veins, and the right ventricle, which pumps this blood via the pulmonary artery into the lungs. When the tricuspid becomes dysfunctional, much of the blood pumped by the right ventricle flows back into the right atrium instead of going into the lungs. This loss of efficiency can lead to progressive right-sided heart failure.
“This investigation highlights the expanding role of cardiac MRI in the assessment of patients with valvular heart disease,” said co-senior author Dr. Dipan Shah , professor of cardiology at Houston Methodist Research Institute and a professor of medicine at Weill Cornell Medicine. “Its unique ability to precisely quantify valvular heart lesions and the associated cardiac remodeling in both the left and right heart makes it an indispensable tool for comprehensive clinical evaluation.”
Conventional RVEF, a basic measure of the right ventricle’s pumping efficiency, is an estimate of right ventricular volume when filled and when fully compressed during pumping. But this measure cannot distinguish between normal blood outflow to the lungs and abnormal backflow to the right atrium. Thus, in patients with tricuspid regurgitation, RVEF may seem normal until the resulting heart dysfunction is relatively advanced.
“The tricuspid valve was once considered the ‘forgotten valve,’ managed primarily with medical therapy and occasionally treated surgically,” said study co-first author Dr. Robert Zhang , an assistant professor of medicine at Weill Cornell Medicine and a cardiologist at NewYork-Presbyterian/Weill Cornell Medical Center. “Now we have less-invasive, catheter-based treatment options, which is incredibly exciting. But with that comes a new challenge: identifying the patients who are most likely to benefit and determining the right timing for intervention.”
Dr. Pablo Villar-Calle , an instructor of medicine at Weill Cornell, is the other co-first author on the paper.
The new measure, eRVEF, is derived from a more direct, magnetic resonance imaging-based estimate of blood flow from the right ventricle to the lungs. In principle, it enables a more accurate assessment of right ventricle function and the degree of tricuspid regurgitation.
The study covered an initial cohort of 453 patients from NewYork-Presbyterian/Weill Cornell Medical Center, plus 316 patients in two independent validation cohorts, 239 from Houston Methodist DeBakey Heart and Vascular Center and 77 from Duke University Medical Center. All patients had at least a moderate degree of tricuspid regurgitation.
The researchers showed firstly that eRVEF is a useful measure in its own right. In all cohorts, patients with impaired eRVEF—defined as less than 25% of right ventricle-filled volume—had strikingly greater risks of adverse outcomes during several years of follow-up, including worse tricuspid regurgitation and mortality, compared with patients who didn’t meet the impaired-eRVEF threshold.
The team also compared eRVEF with RVEF, showing that adding eRVEF to a prediction model that already included RVEF significantly improved mortality prediction, whereas adding RVEF to a model that already included eRVEF did not.
The results suggest that in the context of at least moderate tricuspid regurgitation, eRVEF is better than RVEF for assessing right-side heart function.
The team now hopes to show with forward-looking studies that using eRVEF to select patients for tricuspid valve treatments can improve outcomes.
“We are also interested in understanding how useful eRVEF may be as a marker of treatment response and whether it can serve as a meaningful endpoint for assessing the success of therapeutic interventions,” Dr. Zhang said.
This study was supported by funding from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, through grant number K23HL140092.
JACC Cardiovascular Imaging
17-May-2026