Exploring three-dimensional right ventricular shape and function in Tetralogy of Fallot patients.

Prognostic Value of Right Ventricular Circumferential Strain in Patients Undergoing Isolated Tricuspid Valve Surgery.

BACKGROUND Right ventricular (RV) function is closely associated with prognosis in isolated tricuspid regurgitation. Beyond conventional longitudinal indexes, nonlongitudinal RV deformation may provide additional prognostic information. OBJECTIVES The authors aimed to evaluate whether 3-dimensional (3D) RV circumferential strain (RV-CS) provides incremental prognostic value in patients undergoing isolated tricuspid valve surgery (ITVS). METHODS Patients scheduled for ITVS were prospectively enrolled and underwent 3D echocardiography 1 day before surgery. 3D RV longitudinal strain, CS, and area strain were derived using commercially available software. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization. RESULTS From April 2018 to December 2024, 251 patients were enrolled; 171/251 (68.1%) were women, and the mean age was 57 ± 14 years. During a median follow-up of 495 days, 48/251 patients (19.1%) reached the primary endpoint. Baseline 3D right ventricular circumferential strain (3D RV-CS) was lower in patients with events than in those without events (P < 0.001) and showed modest but had the highest Harrell's C-index for adverse events discrimination (0.695; 95% CI: 0.618-0.774; P < 0.001) among all tested RV function parameters. Patients with impaired 3D RV-CS, defined as |3D RV-CS| < 14%, had lower 1-year event-free survival than those with preserved 3D RV-CS (54.2% vs 92.5%; log-rank P < 0.001). After multivariable adjustment, impaired 3D RV-CS remained independently associated with adverse events. Adding 3D RV-CS improved risk reclassification beyond European System for Cardiac Operative Risk Evaluation II, TRI-SCORE, and Society of Thoracic Surgeons score models. CONCLUSIONS 3D RV-CS provides complementary prognostic information in patients undergoing ITVS and may improve preoperative risk stratification.

Baseline Right Ventricular Assessment and Outcomes After Transcatheter Tricuspid Valve Repair

Tricuspid regurgitation (TR) and right ventricular (RV) remodelling are closely related. Recent ESC/EACTS guidelines on valvular heart disease propose adjusted reference values for RV size and function. To determine the predictive value of the proposed RV dilatation and dysfunction thresholds in a real-world interventional cohort. Echocardiographic thresholds were evaluated retrospectively in 651 patients, who underwent transcatheter tricuspid valve repair (TTVr) at two tertiary centres. The primary endpoint was 2-year survival (Kaplan–Meier estimate: 78.6% [74.9–81.9]). RV strain was the most frequent marker of dysfunction at baseline (FWS <23% in 80.3%, GLS <21% in 88.4%). Proposed cut-offs for RV basal (>24 mm/m2), mid (>21 mm/m2), and tricuspid annular (TA) diameters (>21 mm/m2) were associated with survival (p=0.04, <0.01, and <0.01). TAPSE <17 mm was not (p=0.24), whereas TDI s’ <10 cm/s and FAC ≤35% were associated with survival (p=0.04; 0.01). Severe RV dysfunction (FWS <11% or GLS <9%) was associated with survival (p<0.01; 0.02). In multivariable analysis, TA >21 mm/m2 (HR 2.85 [1.41–5.76]; p<0.01) and FWS <11% (HR 1.91 [1.07–3.38]; p=0.03) independently predicted survival. Mortality risk increased for each additional pathological parameter (HR per parameter 1.33 [1.14–1.57]; p <0.01). After effective TR reduction (residual TR <I; n=341, 52%), no RV cut-off remained associated with survival. TTVr is often performed at an advanced disease stage, and adverse RV remodelling is strongly associated with survival. Nevertheless, effective TR reduction attenuated this prognostic value.

Characteristic flow of different right ventricular outflow tract morphology in repaired tetralogy of fallot patients studied by 4D-flow cardiac magnetic resonance images.

BACKGROUND Right ventricular outflow tract (RVOT) morphology may influence hemodynamics and suitability for transcatheter pulmonic valve implantation (PPVI) in patients with repaired tetralogy of Fallot (rTOF). METHODS We retrospectively analyzed 120 rTOF patients who underwent cardiovascular magnetic resonance (CMR) imaging with 4D-flow analysis. RVOT morphology was classified as tubular, pyramidal, or trapezoid, with inverted pyramidal and concave morphologies absent. Due to small numbers in minor groups, analysis focused on tubular (n = 86) and pyramidal (n = 22) RVOTs. Conventional CMR parameters, including ventricular volumes, function, pulmonic valve (PV) annulus size, and pulmonary regurgitation (PR), as well as 4D-flow hemodynamic parameters, were compared between groups. RESULTS The tubular and pyramidal RVOT groups showed no significant differences in patient demographics, transannular patch history, long-term clinical events (arrhythmia, pulmonic valve replacement necessity), or conventional CMR measures of LV/RV volumes, function, or PR severity. However, the 4D-flow analysis revealed distinct hemodynamic profiles. The tubular RVOT group generally demonstrated a higher hemodynamic load than the pyramidal group, specifically showing higher peak velocity at the RVOT (but lower at the RPA), higher maximum magnitude wall shear stress (WSS) at the RVOT, PV, and MPA (but lower at the RPA), higher average magnitude WSS at the PV and MPA and greater average energy loss at PV. CONCLUSIONS Despite similar conventional CMR findings and clinical outcomes, the tubular RVOT morphology is associated with a significantly higher local hemodynamic profile across the PV and MPA compared to the pyramidal morphology. This suggests that advanced 4D-flow parameters are more sensitive to morphological differences and may be important for risk stratification and understanding the long-term integrity of the different RVOT morphologies.

Agreement of AI-assisted semi-automated right ventricular function analysis using 3D transthoracic echocardiography with artificial intelligence.

AI-based 3D TTE semi-automated measurement has the potential to enhance the efficiency and reproducibility of RV function assessment, reducing examiner workload and improving clinical workflow.

EXPLORATORY ASSESSMENT OF LEFT VENTRICULAR 1 STRAIN-VOLUME LOOPS IN SEVERE AORTIC VALVE 2 DISEASES

The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

Background Ventricular pre-excitation can cause left ventricular (LV) mechanical dyssynchrony and dysfunction. However, the specific impact of accessory pathway (AP) location on LV mechanics remains incompletely characterized. This study utilized two-dimensional speckle-tracking echocardiography (2D-STE) to quantify and compare LV deformation and synchrony across these anatomical subgroups. Methods We retrospectively analyzed 91 patients with Wolff-Parkinson-White (WPW) syndrome (age 38.2±1.4 years) and 56 matched controls using 2D-STE. Global and regional LV deformation and synchrony were compared across AP-location groups: septal (n=34), right (n=38), and left (n=19). LV deformation parameters included circumferential strain (CS), longitudinal strain (LS), and radial strain (RS). LV synchrony was assessed by peak strain dispersion (PSD) of LV segments for each strain direction. Results All patient groups (septal: −19.0%±0.7%, right: −19.3%±0.6%, and left AP: −19.2%±0.8%) had lower global CS (GCS) compared with controls (−23.1%±0.4%, all P<0.001). The septal AP group showed lower global LS (GLS) (−17.2%±0.5%), global RS (GRS) (30.1%±2.0%), and prolonged GLS-PSD (51.3±3.1 ms) than the left AP group and controls (P<0.05). The right AP group exhibited lower GLS (−17.5%±0.5%) than the left AP group (−19.6%±0.5%, P<0.05) and prolonged GLS-PSD (46.7±2.5 ms) compared with controls (31.6±1.1 ms, P<0.001). The left AP group showed GLS (−19.6%±0.5%), GRS (40.0%±2.6%), and GLS-PSD (40.1±2.3 ms) that were not significantly different from controls (all P>0.05). LV ejection fraction (LVEF) was lower in septal (59.2%±1.2%) and right AP groups (59.8%±1.0%) vs. controls (65.0%±0.3%; P<0.001). LVEF correlated negatively with GLS (r=−0.53, P<0.001) and with GLS-PSD (r=−0.41, P<0.001). Conclusions LV mechanical dysfunction in WPW syndrome varies by AP location. Septal and right APs lead to widespread strain impairment, dyssynchrony, and lower LVEF, whereas left APs mainly reduce CS. Reduced LVEF is closely associated with impaired LV mechanics and dyssynchrony.