At Weill Cornell Medicine and NewYork-Presbyterian, cardiologists have developed a sharper way to see what's going wrong with the heart's most overlooked valve—and when to step in before it's too late. The breakthrough is a new cardiac MRI measurement called effective right ventricular ejection fraction, or eRVEF, that predicts mortality risk in patients with tricuspid regurgitation far more accurately than the traditional tools doctors have relied on for years.
Tricuspid regurgitation is a common but serious condition in which the tricuspid valve—the gateway between the heart's right atrium and right ventricle—fails to close properly. Blood meant for the lungs gets shunted backward, forcing the right side of the heart to work harder with less efficiency. Left untreated, this progressive dysfunction leads to right-sided heart failure. Until recently, physicians had few options beyond medical management, but the arrival of less-invasive, catheter-based treatments has created a new clinical urgency: identifying which patients will truly benefit and when to act.
The problem is that conventional measures of right ventricular function don't tell the full story. The standard metric, RVEF, estimates the heart's pumping power based on volume alone—how much blood the right ventricle holds when full and how much it ejects when it contracts. But this measure cannot distinguish between normal blood flowing to the lungs and abnormal blood leaking backward into the atrium. For patients with tricuspid regurgitation, the result is often a deceptively normal reading that masks advanced dysfunction until irreversible damage has set in.
eRVEF works differently. Rather than estimating from volume alone, this MRI-derived measurement directly assesses the actual blood flow from the right ventricle to the lungs—the output that matters clinically. This precision allows cardiologists to detect disease progression much earlier and make more informed treatment decisions. Dr. Jiwon Kim, the study's corresponding author and director of the Cardiovascular Imaging Program at Weill Cornell Medicine, explains the clinical stakes: "Our goal in tricuspid regurgitation is to detect disease progression and intervene before irreversible heart dysfunction develops."
The researchers published their findings in JACC: Cardiovascular Imaging after analyzing data from nearly 800 patients across three major medical centers. An initial cohort of 453 patients came from NewYork-Presbyterian/Weill Cornell Medical Center, with independent validation cohorts of 239 patients from Houston Methodist DeBakey Heart and Vascular Center and 77 from Duke University Medical Center. All patients had at least moderate tricuspid regurgitation. The results were striking: patients with impaired eRVEF—defined as less than 25% of right ventricle-filled volume—showed substantially elevated mortality risk compared to those with better eRVEF values.
The tricuspid valve was once dismissed as the "forgotten valve," says Dr. Robert Zhang, a co-first author and cardiologist at NewYork-Presbyterian/Weill Cornell. The arrival of catheter-based treatments has changed that, but only if doctors can identify the right patients at the right time. eRVEF offers that clarity. As cardiac MRI continues to prove its unique ability to precisely quantify valve disease and detect cardiac remodeling across both sides of the heart, this new measurement represents a significant step forward in transforming how physicians evaluate and manage tricuspid regurgitation.