Decoding Right Ventricular Geometry: Novel 3D Echocardiography-Derived Global Shape Analysis Across Health and Disease States.

Abstract

Aims: While pre-defined reference shapes have been used to assess morphological changes in the left ventricle, standardized methods for evaluating right ventricular (RV) remodeling are lacking. This study aimed to develop and test a new 3D echocardiography (3DE)-based method for quantifying RV shape in a large cohort of healthy individuals and across various disease states.

Methods and results: 3DE-derived RV mesh models were reconstructed in 1043 healthy subjects from the World Alliance of Societies of Echocardiography (WASE) study and in 581 patients with severe aortic stenosis (AS), heart failure with reduced ejection fraction (HFrEF), post-heart transplantation (HTX), severe primary mitral regurgitation (MR), atrial secondary tricuspid regurgitation (A-STR), tetralogy of Fallot (TOF) and pulmonary hypertension (PH). To assess global RV shape, hemi-sphericity volume ratio (HSVR) and hemi-conicity angle (HCA) were calculated, where a higher HSVR and a more acute HCA reflect more spherical and conical shapes, respectively. In the WASE population, females had more spherical RVs, whereas males had more conical RVs (p=0.028). Considering age, younger females had more conical RVs, while older individuals in both sexes showed spherical remodeling (p<0.05). Comparing disease groups with WASE controls, MR, HFrEF, and A-STR patients had more spherical RVs compared to controls (both p<0.001), while PH and TOF patients showed conical remodeling (both p<0.001). In A-STR, a more conical remodeling was associated with adverse clinical outcomes.

Conclusion: The proposed 3DE method comprehensively characterizes RV geometry, demonstrating demographic variation in healthy individuals and disease-specific alterations in patients, with important prognostic implications.