Bridging The Gap: A Comparative Study Of Papi, Transesophageal Echocardiogram, And Cardiac Computed Tomography For Right Ventricular Function In Transcatheter Tricuspid Valve Replacement
Recommended Citation
Mohammed M, Saleem M, Fram G, Obeidat L, Dawdy J, Alrayes H, Kar Lok Lai L, Alter J, Lai K, Bowerman N, Engel Gonzalez P, Villablanca P, Frisoli T, O’Neill BP, Zweig B, Lee J, Parikh S. Bridging The Gap: A Comparative Study Of Papi, Transesophageal Echocardiogram, And Cardiac Computed Tomography For Right Ventricular Function In Transcatheter Tricuspid Valve Replacement. J Cardiovasc Comput Tomogr 2025; 19(4):S50.
Document Type
Conference Proceeding
Publication Date
7-1-2025
Publication Title
J Cardiovasc Comput Tomogr
Abstract
Introduction: The pulmonary artery pulsatility index (PAPi) is a widely used hemodynamic parameter for assessment of right ventricular (RV) function, particularly in patients undergoing cardiac surgery or experiencing cardiogenic shock. In this study, we aim to evaluate the correlation between invasive PAPi and imaging-based assessment of RV size and function using transesophageal echocardiogram (TEE) and ECG-gated cardiac computed tomography (CCT) in patients undergoing transcatheter tricuspid valve replacement (TTVR) with Evoque valve (Edwards Lifesciences, USA). Methods: A retrospective analysis was conducted on 42 patients who underwent TTVR between February 2024 to January 2025. All patients had pre-procedural imaging with TEE and CCT to assess RV size and function. We compared PAPi with various RV parameters obtained from TEE and CCT, including fractional area change (FAC), RV volumetric ejection fraction (EF), fractional shortening, basal fractional shortening, and free wall shortening on CCT. Additionally, baseline RV size, RV function and RV basal diameter were assessed using TEE. Results: A total of 42 patients were analyzed, with the majority (83%) classified as NYHA functional class of III or greater. Multiple regression analysis was performed to compare PAPi with imaging-derived RV parameters. No correlation was found between pre-TTVR invasive PAPi and RV size or function measured by TEE or CCT, with an adjusted R-squared value of <0.05 for all variables. However, a direct comparison of FAC on TEE immediately pre and post TTVR demonstrated a reduction in RV function (Figure 1). Further analysis was conducted on RV size and function using paired T-test which indicated a statistically significant drop in RV function and increase in RV size post-TTVR with a p value of <0.05 for both. Conclusions: In this single-center study, we found no significant correlation between invasive PAPi measurements and CCT or TEE-derived measurements of RV size and function. However, a decline in FAC post-TTVR was observed, likely reflecting the acute change in RV loading conditions following the intervention which aligns with prior studies. These results suggest that CCT and TEE may have limitations in assessing RV reserve. These findings highlight the continued importance of invasive measurements like PAPi for a more comprehensive evaluation of RV function, particularly in patients undergoing tricuspid valve replacement. Further research is needed to determine the clinical implications of these findings. [Formula presented]
Volume
19
Issue
4
First Page
S50
