Development and prognostic validation of partition values to grade right ventricular dysfunction severity using 3D...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Imaging

Background:

• Transthoracic 3D echocardiography (3DE) accurately measures right ventricular ejection fraction (RV EF) compared to cardiac magnetic resonance (CMR).
• Current RV EF assessment categorizes it as normal (>45%) or abnormal (≤45%), lacking finer stratification for dysfunction severity.

Purpose of the Study:

• To establish partition values for RV EF to classify dysfunction as mild, moderate, or severe.
• To validate the prognostic significance of these partition values in an independent patient cohort.

Main Methods:

• 3DE was used to derive RV EF partition values in 412 patients.
• A K-Adaptive partitioning algorithm identified mortality-stratifying RV EF groups.
• These partition values were validated in an independent cohort of 446 patients for cardiac death and MACE risk.

Main Results:

• RV EF partition values were identified as: >46% (very low), 40.9%-46% (low), 32.1%-40.9% (moderate), and ≤32.1% (high).
• Simplified partition values of 45%, 40%, and 30% were proposed for clinical use.
• These values effectively stratified cardiac death and MACE risk in the validation cohort.

Conclusions:

• RV EF, measured by 3DE, has independent prognostic value in heart disease patients.
• The identified partition values enable risk stratification for cardiac death and MACE, improving patient management.