Aug 2026· JACC: Asia· Vol 6, pp. 1972 - 1984· 1 citation· 37 references
Medicine
TL;DR
3D RV-CS provides complementary prognostic information in patients undergoing ITVS and may improve preoperative risk stratification and improve risk reclassification beyond European System for Cardiac Operative Risk Evaluation II, TRI-SCORE, and Society of Thoracic Surgeons score models.
Abstract
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.
BACKGROUND
The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated.
OBJECTIVES
This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort.
METHODS
Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention.
RESULTS
A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint.
CONCLUSIONS
The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
X. Galloo, M. Dietz, E. Prihadi et al.· JACC Cardiovascular Imaging· 0 citations
After effective TR reduction (residual TR <I; n=341, 52%), no RV cut-off remained associated with survival, and effective TR reduction attenuated this prognostic value.
J. Althoff, Jennifer von Stein, Philipp von Stein et al.· European Heart Journal· 0 citations
BACKGROUND
A careful preoperative evaluation of patients with mitral regurgitation (MR) is pivotal to optimize the timing of intervention and clinical outcome. The aim of this study was to evaluate preoperative prognostic parameters, among basic and speckle tracking echocardiography (STE), in patients undergoing MR surgery.
METHODS
We prospectively enrolled patients with severe MR who underwent preoperative clinical, biohumoral and echocardiographic evaluation, before mitral valve surgery. After surgery, patients were followed to investigate clinical outcome. The primary endpoint was a composite of heart failure hospitalizations and all cause-mortality, the secondary endpoint was to identify the best predictors of postoperative functional capacity assessed by New York heart association (NYHA) class.
RESULTS
The final study cohort consisted of 110 patients with a mean age of 64 ± 13 years, 59% male. All strain parameters were reduced, while myocardial work (MW) showed normal values. Median follow-up was 17 (10-29) months. The primary endpoint occurred in 10 patients. Two echocardiographic predictors for the primary endpoint were global peak atrial longitudinal strain (PALS) ≤ 21.5% and free wall right ventricular longitudinal strain (fwRVLS) ≥ -22% with ROC curves. The study population was then divided into 3 groups (Group 1, n = 32: PALS>21.5% and fw-RVLS < -22%, Group 2, n = 46: either global PALS or fwRVLS reduced, Group 3, n = 32: PALS ≤ 21.5% and fwRVLS ≥ -22%). Kaplan-Meier curves showed good risk stratification of the composite endpoint across the three groups. Global wasted work(GWW) was an independent predictor of symptoms persistence (NYHA class > II) at follow-up.
CONCLUSIONS
STE, particularly with the combination of left atrial and right ventricular strain analysis, can provide additional prognostic value for the preoperative evaluation of patients with MR referred for surgery.
M. Pastore, F. Marrese, A. Marchese et al.· International Journal of Car...· 0 citations
Right ventricular free-wall longitudinal strain is a robust determinant of adverse outcomes beyond conventional LV indices and A4C-LVLS in VFMR and might be incorporated into routine evaluation to improve risk stratification in VFMR.
Chung-Yen Lee, Chi-Han Wu, Hsuan-Hao Hsu et al.· Journal of the American Soci...· 0 citations
The right ventricular contractile pattern is altered after heart transplantation (HT). This study aims to use three-dimensional echocardiography (3DE) to comprehensively assess right ventricular contractile pattern in HT patients.
In a cohort of 200 adult HT recipients, we serially assessed 3DE RV contraction patterns—including global (RVEF), longitudinal (LEF), radial (REF), and anteroposterior (AEF) ejection fractions—from the early post-operative period to 3 years. 50 HT patients were compared to matched healthy controls and open-heart surgery patients. Sex-specific reference values were derived.
RV function parameters improved within the first year (all
P
< 0.05), then stabilized. At 1 year, HT recipients exhibited a distinct 3D contraction pattern compared to controls: attenuated longitudinal and anteroposterior function (LEF: 18.2% vs. 28.6%; AEF: 23.8% vs. 25.4%;
P
< 0.05) with compensatory enhanced radial contraction (REF: 29.8% vs. 24.6%;
P
< 0.05). Established reference ranges confirmed this phenotype. Cardiopulmonary bypass time were key determinants of this pattern.
HT recipients develop a unique, stabilized RV contraction pattern by one year, characterized by a shift from longitudinal to radial dominance.
Yu-Ji Xie, Wei Sun, Lin-Yue Zhang et al.· Frontiers in Cardiovascular...· 0 citations
Background Outcomes after transcatheter aortic valve replacement (TAVR) reflect cumulative myocardial injury beyond stenosis. Left ventricular (LV) and right ventricular (RV) dysfunction may present as overlapping but distinct functional profiles in aortic stenosis; the prognostic significance of their coexistence remains uncertain. Objectives This study evaluated whether quantitative phenotype-based classification integrating LV longitudinal mechanics and RV–pulmonary arterial (PA) coupling identifies distinct preprocedural functional profiles and improves 1-year risk stratification after TAVR. Methods In 280 registry patients undergoing TAVR, LV mechanics were assessed by LV global longitudinal strain (LVGLS), and RV-PA coupling by RV free-wall longitudinal strain–to–pulmonary artery systolic pressure ratio (RVFWLS/PASP). Four LV/RV profiles were defined: no abnormality, isolated LV impairment, isolated RV impairment, and concurrent abnormalities. For modeling, isolated LV and RV impairments were combined as single-axis abnormality. The primary endpoint was 1-year all-cause death or major adverse cardiovascular events. Results The median follow-up was 368 days (IQR: 312-371 days). The 4 profiles included 113/280 (40.4%) no abnormality, 83/280 (29.6%) isolated LV impairment, 22/280 (7.9%) isolated RV impairment, and 62/280 (22.1%) concurrent abnormalities patients. The primary endpoint occurred in 8/113 (7.1%; 95% CI: 3.1-13.5), 16/83 (19.3%; 95% CI: 11.4-29.4), 6/22 (27.3%; 95% CI: 10.7-50.2), and 33/62 (53.2%; 95% CI: 40.1-66.0) (log-rank P < 0.001). Concurrent abnormalities carried the highest adjusted risk (HR: 5.70; 95% CI: 2.37-13.73; P < 0.001) and improved discrimination (C-index: 0.731 [95% CI: 0.682-0.790] to 0.771 [95% CI: 0.724-0.836]). Conclusions Integrating LV longitudinal mechanics and RV-PA coupling identifies distinct preprocedural phenotypes in TAVR patients. Concurrent biventricular impairment denotes a high-risk phenotype and provides incremental risk stratification information for 1-year post-TAVR outcomes.
Ying-Qi Liu, Z. Ge, Wen Liu et al.· JACC: Asia· 1 citation
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