How should right ventricle remodeling be assessed in women and men with chronic mitral regurgitation?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Haukeland University Hospital Introduction Right ventricular (RV) dysfunction has a negative impact in patients with mitral regurgitation (MR), yet its assessment by two-dimensional (2D) echocardiography remains challenging. It is unclear which echocardiographic parameter best reflects RV remodeling in chronic MR. Purpose To assess 2D and three-dimensional (3D) measures of RV size and function in relation to MR severity. Methods Patients in the 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study with moderate or severe MR by combined transthoracic/transesophageal assessment and no other severe valve disease were examined at our heart valve clinic between 2020–2022. RV remodeling was assessed in 2D by the basal diameter, tissue Doppler peak systolic velocity at the lateral tricuspid ring (RV s´), tricuspid annular plane systolic excursion (TAPSE), and RV free wall longitudinal strain (RV FWS); and in 3D by end-diastolic volume (3D RVEDV), end-systolic volume (3D RVESV), ejection fraction (3D RVEF) and fractional area change (3D RVFAC). Results 100 patients with moderate or severe MR (54 with degenerative MR; 26 with atrial functional MR; 20 with ventricular functional MR) were included. Women (n=38) had smaller MR regurgitation volumes and RV size, similar TAPSE and RV s´, but higher 3D RVEF, 3D RVFAC and RV strain normalized for 3D RVEDV (all p <0.05). More severe RV remodeling with larger volumes, and lower 3D RVFAC (all p <0.05), and 3D RVEF (p = 0.05) was detected in severe MR by 3D, but not by 2D RV measures (Figure). In ROC analyses, 3D RVESV was strongest associated with severe MR (area under curve 0.68, p <0.01, Figure). In linear regression analysis, increasing 3D RVESV was associated with higher body mass index, larger MR regurgitation volume, male sex, and larger 3D left atrial volumes (R2 0.48, p <0.001). Conclusion RV remodeling in severe MR is detected by 3D, but not by routine 2D echocardiography. The 3D RV end-systolic size best reflects MR severity.