PhD Scientific Days 2026

Poster Session 2.Q - Cardiovascular Medicine and Research

Discordant Severity Grading in Right Ventricular Dysfunction: Prognostic Implications of Conventional Parameters versus 3D Echocardiography-Derived Ejection Fraction

Name of the presenter

Tolvaj, Máté

Institute/workplace of the presenter

Heart and Vascular Center, Semmelweis University

Authors

Máté Tolvaj¹, Elena Surkova², Denisa Muraru³, Yasufumi Nagata⁴, Masaharu Kataoka⁴, Yosuke Nabeshima⁵, Noela Radu³, Alexandra Simona Buta³, Alexandra Clement³, Bálint Lakatos¹, Alexandra Fábián¹, Andrea Ferencz¹, Márton Tokodi¹, Tímea Katalin Turschl¹, Michele Tomaselli³, Francesco Perelli³, Masaaki Takeuchi⁶, Béla Merkely¹, Luigi P. Badano³, Attila Kovács¹
1: Heart and Vascular Center, Semmelweis University
2: Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust
3: Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital
4: Second Department of Internal Medicine, University of Occupational and Environmental Health
5: Department of Cardiovascular Medicine, Saga University
6: Department of Cardiovascular Medicine, Tobata General Hospital

Text of the abstract

Introduction
The 2025 American Society of Echocardiography guidelines on the right heart introduce severity grading for right ventricular (RV) dysfunction based on individual functional parameters. However, single-parameter assessment may result in inconsistent diagnosis of RV dysfunction and discordant grading of its severity.
Aims
We aimed to investigate the prognostic value and discordance among RV functional echocardiographic parameters.
Method
We analyzed 2D and 3D echocardiographic data from three centers, including 1146 consecutive patients followed for the composite endpoint of all-cause mortality and heart failure hospitalization. RV dysfunction severity was graded using the guideline-recommended cutoff values for tricuspid annular plane systolic excursion (TAPSE), fractional change (FAC) and free wall longitudinal strain (FWLS), and compared with severity assessment based on RV ejection fraction (RVEF).
Results
Over a median follow-up of 3.2 years, 261 patients (23%) met the composite endpoint. Assessed by RVEF, worsening RV dysfunction categories carried a higher risk for meeting the composite endpoint, significant between mild vs normal and moderate vs mild dysfunction (HRs: 2.385 [95% CI: 1.720–3.307], p<0.001, and 1.581 [95% CI: 1.066–2.346], p=0.023), but not between severe vs moderate dysfunction. TAPSE and FWLS did not show a significant difference in risk between the dysfunction categories. FAC identified a significant risk difference between adjacent severity categories only for moderate vs mild dysfunction (HR: 1.928 [95% CI: 1.309–2.840], p<0.001). Agreement with RVEF in patients with dysfunction was poor for TAPSE (quadratic weighted κ=0.06, p=0.13) and fair for FAC and FWLS (κ=0.34, p<0.001, and κ=0.30, p<0.001, respectively).
Conclusion
Significant discordance exists between conventional echocardiographic parameters of RV function and RVEF in grading RV systolic dysfunction. None of the individual RV functional parameters provided consistent risk stratification, highlighting the limited prognostic utility of isolated parameters.
Funding
Supported by the 2025-2.1.1-EKÖP-2025-00014 (EKÖP-2025-596) University Research Scholarship Programme of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.