ArticleJACC. Cardiovascular imaging2025
Nonischemic Septal Fibrosis in Functional Tricuspid Regurgitation Provides Incremental Stratification of Adverse Remodeling and Prognosis.
Article in JACC. Cardiovascular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Tricuspid regurgitation: standardized stepwise work-up from referral to expert heart valve centre.European heart journal · 2026Review
- RACI: A Novel Prognostic Marker in Functional Tricuspid Regurgitation.Circulation. Cardiovascular imaging · 2026Article
- Myocardial remodeling in valvular heart disease: pathophysiology, multimodality imaging and treatment implications.Heart failure reviews · 2026Review
- Prognostic Modeling of Tricuspid Valve Regurgitation Outcomes Using Machine Learning-Based Survival Analysis.Journal of clinical medicine · 2026Article
- Clinical and imaging phenotypes.European heart journal supplements : journal of the European Society of Cardiology · 2026Article
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Authors and funding
16 authors.
Funding
Abstract
backgroundFunctional tricuspid regurgitation (TR) arises from impaired valve integrity resulting from contractile dysfunction, chamber dilation, or myocardial tissue alterations. Whereas right ventricular (RV) dysfunction is a recognized driver of adverse outcomes in TR, the impact of myocardial tissue injury, particularly nonischemic septal fibrosis (NIsF), remains largely unexplored.
objectivesThis study aims to evaluate the association of NIsF with adverse right-sided chamber remodeling and to assess its incremental prognostic value for mortality in patients with functional TR.
methodsPatients with advanced (≥ moderate) functional TR underwent comprehensive cardiac magnetic resonance (CMR) evaluation. Late gadolinium enhancement (LGE) was used to identify NIsF, defined as hyperenhancement in the midmyocardial or epicardial regions of the interventricular septum. Cine CMR measured functional and geometric indices of the left and right sides of the heart. Follow-up data were obtained for all-cause mortality.
resultsA total of 663 patients with advanced TR (mean age: 63.8 ± 16.0 years; 53% male) were studied, and 29.4% were found to have NIsF. NIsF was strongly associated with adverse chamber remodeling, including larger left ventricular and RV volumes, reduced systolic function, and increased TR severity (all P < 0.001). TR regurgitant fraction increased stepwise with NIsF extent (no NIsF, 34.9% ± 1.5%; 1 segment, 38.1% ± 13.0%; 2 segments, 40.8% ± 13.8%; P < 0.001). Over a mean follow-up of 4.3 ± 4.3 years, 25.3% of patients died. NIsF was independently associated with mortality (HR: 1.79 [95% CI: 1.26-2.56]; P = 0.001), even after adjusting for conventional risk markers, including age, TR severity, RV dysfunction, and dilation. Kaplan-Meier analysis demonstrated significantly higher mortality risk among patients with NIsF compared with patients without NIsF (P < 0.001).
conclusionsAmong patients with advanced TR, NIsF is an important marker of adverse right-sided chamber remodeling and provides incremental prognostic utility beyond conventional risk markers.
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