PhD Scientific Days 2024

Budapest, 9-10 July 2024

Poster Session N - Cardiovascular Medicine and Research 2.

Old But Not Gold: Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Evaluation of Right Ventricular Systolic Dysfunction

Author(s)

Máté Tolvaj1, Attila Kovács1, Noela Radu2, Andrea Cascella3, Denisa Muraru3, Bálint Lakatos1, Alexandra Fábián1, Márton Tokodi1, Michele Tomaselli3, Mara Gavazzoni3, Francesco Perelli3, Béla Merkely1, Luigi P. Badano3, Elena Surkova4
1: Semmelweis University, Heart and Vascular Centre
2: University of Milano-Bicocca, Department of Medicine and Surgery
3: Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital
4: Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust

Text of the abstract

Introduction:
Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function. In contrast, 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment.
Aims:
We aimed to investigate the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes.

Methods:
We analyzed 2D and 3D echocardiography data from two centers including 750 consecutive patients with various cardiac diseases followed up for the occurrence of all-cause mortality. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE<17 mm, FAC<35%, FWLS>-20%). RVEF <45% served as the “ground truth” of RV dysfunction.

Results:
Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 42 (8%) had reduced FWLS. Among patients with reduced RVEF (n=239), 109 (46%) had normal TAPSE, 61 (26%) had normal FAC, and 98 (41%) had normal FWLS. Based on guideline-recommended cut-off values, sensitivity and specificity of discrimination for RV systolic dysfunction (RVEF<45%) were 55% and 79% for TAPSE, 76% and 67% for FAC, and 59% and 92% for FWLS on ROC analysis. During the median follow-up time of 3.5 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE, FAC, FWLS, and RVEF were all significant predictors of mortality (p<0.001). Interestingly, combining the conventional functional measures based on the number of them indicating dysfunction showed that outcomes are the worst if at least two parameters are impaired and gradually better if only one or none of them (log-rank p<0.005).

Conclusion:
Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cut-off. Our results emphasize a multiparametric approach in the assessment of RV function, especially, if 3D echocardiography is not available.

Funding:
Mate Tolvaj was supported by the EFOP-3.6.3-VEKOP-16-2017-00009 project and by the ÚNKP-23-3-II-SE-40 New National Excellence Program of the Ministry for Innovation and Technology