3D regional evaluation of right ventricular myocardial work from cineCT

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Assessing regional right ventricular (RV) myocardial work (MW) is challenging due to limitations in high-resolution strain estimation.
• Current methods lack the spatial resolution needed for comprehensive RV performance evaluation.

Purpose of the Study:

• To develop and validate a cineCT-based approach for evaluating regional RV myocardial work (MW) in 3D.
• To demonstrate the utility of this method in phenotyping patients with heart failure (HF), chronic thromboembolic pulmonary hypertension (CTEPH), and repaired tetralogy of Fallot (rTOF).

Main Methods:

• Combined ECG-gated cineCT-derived regional strain (RS) with right heart catheterization (RHC) pressure waveforms.
• Created regional pressure-strain loops to measure endocardial MW as loop area.
• Applied detailed 3D mapping of RS and MW for spatial visualization and patient phenotyping.

Main Results:

• Heart failure patients showed significantly impaired RV strain and work compared to CTEPH and rTOF cohorts.
• CTEPH patients exhibited septal wall impairment with negative work, while rTOF patients displayed a wide spectrum of strain and work.
• Impaired RV strain and negative work strongly correlated with RV ejection fraction (RVEF), and impaired MW moderately correlated with RVEF.

Conclusions:

• Regional RV MW maps derived from clinical CT and RHC studies enable patient-specific phenotyping.
• This CT-based assessment of RV MW is a valuable new metric for managing complex RV dysfunction.