Decoding Right Ventricular Function: A Comprehensive Cardiac CT Analysis For Transcatheter Tricuspid Valve Replacement Success
Recommended Citation
Obeidat L, Saleem M, Mohammed M, Fram G, Alter J, Dawdy J, Alrayes H, Kar Lok Lai L, Lai K, Qi Z, Engel Gonzalez P, Villablanca P, Frisoli T, O’Neill BP, Pantelic M, Bowerman N, Song T, Zweig B, Parikh S, Lee J. Decoding Right Ventricular Function: A Comprehensive Cardiac CT Analysis For Transcatheter Tricuspid Valve Replacement Success. J Cardiovasc Comput Tomogr 2025; 19(4):S24-S25.
Document Type
Conference Proceeding
Publication Date
7-1-2025
Publication Title
J Cardiovasc Comput Tomogr
Abstract
Introduction: Severe tricuspid regurgitation (TR) leads to debilitating symptoms and higher mortality. Transcatheter tricuspid valve replacement (TTVR) improves symptoms and quality of life, but accurate assessment of right ventricular (RV) function is essential for patient selection. Echocardiography is commonly used but has limitations. Cardiac CT (CCT) offers high spatial resolution and could serve as a more reliable reference for evaluating RV function. This study evaluates pre-procedural RV function using 2D and volumetric CCT metrics in TTVR candidates. Methods: A retrospective analysis was performed on 42 patients who underwent TTVR using the EVOQUE tricuspid valve replacement system. All patients underwent pre-procedural imaging with CCT. Immediate pre-procedural TEE RV functional metrics were adjudicated by interventional echocardiographers with more than 10 years of experience. CT-based right ventricular function parameters, derived from volumetric and 2D CT data (FAC, tricuspid annular excursion, and RV longitudinal shortening), were compared to expert-adjudicated TEE standard parameters for RV function assessment. Correlation analyses were performed using adjusted R2 values. Results: CT RV volumetric ejection fraction showed a superior correlation with CT FAC (AdjR2 = 0.53) compared to CT RV free wall shortening (AdjR2 = 0.25), CT basal fractional shortening (AdjR2 = 0.38), and CT RV fractional shortening (AdjR2 = 0.02). It did not exhibit a strong correlation with TEE FAC either before or after the intervention (AdjR2 = 0.11 and -0.01, respectively).CT FAC demonstrated a strong correlation CT RV free wall shortening (AdjR2 = 0.42), and CT basal fractional shortening (AdjR2 = 0.56), while its correlation with CT RV fractional shortening was weaker (AdjR2 = 0.33). Similar to CT RV volumetric ejection fraction, CT FAC did not show a strong correlation with TEE FAC pre- or post-intervention (AdjR2 = 0.12 and -0.02, respectively). Conclusions: Pre-procedural CCT assessment of RV function is crucial for patients undergoing TTVR. Our findings reveal that echocardiographic RV metrics show poor correlation with CCT-based reference standards, highlighting the limitations of echocardiography. As pre-procedural CCT is routinely performed for TTVR, incorporating CT-based RV function metrics could provide more reliable and detailed information, potentially improving patient selection and predicting clinical outcomes more accurately. [Formula presented]
Volume
19
Issue
4
First Page
S24
Last Page
S25
