Tricuspid Annular Geometry as a Marker of Right Ventricular Function and Remodeling

Area of Science:

• Cardiovascular imaging and hemodynamics.
• Echocardiography and cardiac surgery.

Background:

• Right ventricular (RV) remodeling is crucial in cardiovascular disease progression.
• Assessing RV-pulmonary artery (PA) coupling is vital for understanding RV function.
• Current methods for evaluating RV-PA coupling and remodeling can be limited.

Purpose of the Study:

• To investigate the association between dynamic 3D tricuspid valve (TV) indices and RV-PA coupling.
• To determine if 3D TV metrics can serve as surrogate markers for RV remodeling.

Main Methods:

• Prospective observational cohort study involving 53 adult patients undergoing cardiac surgery.
• Intraoperative 3D transesophageal echocardiography and PA catheterization were performed.
• RV-PA coupling was quantified using single-beat pressure-volume methods, with impaired coupling defined as an end-systolic elastance (Ees)/effective arterial elastance (Ea) ratio <0.8.

Main Results:

• Seventeen patients (32%) exhibited impaired RV-PA coupling.
• Impaired coupling was associated with reduced annulus area change (11.9% vs 15.8%) and increased indexed tenting volume (1.04 mL/m² vs 0.72 mL/m²).
• Annulus area change positively correlated with Ees/Ea (R² = 0.96), while indexed tenting volume inversely correlated (R² = 0.95).

Conclusions:

• Diminished tricuspid annular dynamism and increased leaflet tenting are linked to impaired RV-PA coupling.
• Dynamic 3D TV metrics show potential as early indicators of RV remodeling.
• These findings may enhance the non-invasive assessment of RV function and remodeling.