"Beyond 2D Echocardiography: A Novel Multiparametric Assessment of Right Ventricular Dysfunction in Transcatheter Tricuspid Valve Repair".

Abstract

Background: Right ventricular (RV) heart failure as assessed by RV to pulmonary artery coupling (RVPAc) is a prognostic marker in transcatheter tricuspid valve repair (T-TEER). However, quantification of RVPAc components by 2D echocardiography in patients with severe tricuspid regurgitation (TR) has significant limitations, and the traditional RVPAc parameter neglects the degree of volume overload/dilatation of the RV, which is another key clinical indicator for right ventricular dysfunction (RVD).Therefore, we aimed to assess RVD by a novel RVPAc parameter, including the three important drivers of RVD, for an improved prediction of 1-year mortality after T-TEER.

Methods: We analyzed 262 patients undergoing T-TEER with complete 3D RV echocardiography and 1-year follow-up.

Results: Increased 3D-RV enddiastolic volume (3D-RVEDV: HR 1.85; 1.10-3.12; p=0.020) and impaired RV free wall longitudinal strain (RVFWLS: hazard ratio (HR) 1.73, 1.02-2.92, p=0.042) predicted 1-year mortality. A novel RVPAc parameter [RVFWLS/(3D-RVEDV*sPAP_invasive)] including all 3 important drivers for RVD was developed, associating RVPA-uncoupling with a tripled risk for 1-year mortality (HR 3.19, 1.7-6.0, p<0.001). The novel RVPAc parameter significantly outperformed the traditional non-invasive RVPAc parameter in 1-year mortality prediction (c-index: 0.68 vs. 0.57 for novel vs. traditional non-invasive RVPAc; p=0.027).

Conclusions: The novel RVPAc parameter, integrating RV function, volume stress, and pressure stress is a powerful metric for RV failure and a superior predictor for survival post-T-TEER.