Computed tomography-based evaluation of the right ventricular geometry in chronic volume overload using artificial intelligence

https://doi.org/10.1007/s00392-024-02526-y

Barbara Rubinic (Bad Oeynhausen)1, B. Hülsmann (Bad Oeynhausen)1, M. Gercek (Bad Oeynhausen)1, H. Omran (Bad Oeynhausen)1, K. Friedrichs (Bad Oeynhausen)1, F. Rudolph (Bad Oeynhausen)1, M. Ivannikova (Bad Oeynhausen)1, V. Rudolph (Bad Oeynhausen)1, T. K. Rudolph (Bad Oeynhausen)1, J. Kirchner (Bad Oeynhausen)1

1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland

 

Background

Right ventricular (RV) failure in patients with chronic volume overload due to tricuspid regurgitation is poorly understood. Full cycle cardiac computed tomography (CT) captures the RV geometry and function throughout the cardiac cycle. Artificial intelligence (AI)-driven analysis serves as a time effective tool to analyze a broad spectrum of patients with RV dilation. The aim of the study was to assess the RV geometry across a broad spectrum of RV dilation.

Methods and results

This study includes 147 patients (mean age 77±7; 41% male, mean RV ejection fraction 48%±12%). After employment of artificial intelligence driven RV reconstruction, the cohort was divided into 5 subgroups based on the magnitude of the RV enlargement. The RV was divided into 3 segments (P1-3) and for each segment the diameter was measured in 4-chamber, 2-chamber and right ventricular outflow tract (RVOT) view, along with the area of the segment at the end of the diastole.
Compared to patients with normal RV end diastolic volume (RVEDV), we found that the RV diameter in all 3 views was significantly larger in patients with severe RV dilation (P<0.01). Enlargement of RV diameter was most pronounced in the apical part of the ventricle, additionally the ratio between apical RV diameter to mean RV diameter in 4 chamber view increased with progression of the RV dilation (P< 0.001). Furthermore, apical RV area was consistently enlarged with RV dilation (P<0.001) and ratio between 4-chamber to 2-chamber view increased significantly with progression of RV dilation (P<0.001). There was no difference in RV ejection fraction between the subgroups (P=0.276).

Conclusions

In patients with chronic volume overload, the RV shows the greatest increase of dilation in the apex. With progression of RV dilation, the geometry of the RV changed from a predominantly triangular, conic shape to a spherical, cylindric-like shape.


P1

Group 1 (n=32)

Group 2 (n=28)

Group 3 (n=23)

Group 4 (n=25)

Group 5 (n=37)

P-Value

4-Chamber view

 

 

 

 

 

 

Basal

 

 

 

 

 

 

               absolute Value

46±9

52±6

55±5

56±6

62±6

<0.01

               Relation to Group 1

1

1.13

1.20

1.28

1.35

 

Mid ventricular

 

 

 

 

 

 

               absolute Value

34±9

41±9

41±6

44±6

52±9

<0.001

               Relation to Group 1

1

1.21

1.21

1.29

1.53

 

Apical

 

 

 

 

 

 

               absolute Value

16±8

24±7

26±5

28±6

36±11

<0.001

               Relation to Group 1

1

1.43

1.62

1.75

2.25

 

2-Chamber view

              

 

 

 

 

 

 

Basal Diameter, mm

 

 

 

 

 

 

               absolute Value

69±12

72±10

77±10

82±9

86±10

<0.001

               Relation to Group 1

1

1.04

1.12

1.19

1.25

 

Mid ventricular

 

 

 

 

 

 

               absolute Value

63±12

67±8

75±8

81±11

87±10

<0.001

               Relation to Group 1

1

1.07

1.19

1.29

1.38

 

Apical

 

 

 

 

 

 

               absolute Value

31±8

36±7

42±5

44±8

48±9

<0.001

               Relation to Group 1

1

1.16

1.35

1.42

1.55

 

RVOT

 

 

 

 

 

 

Basal

 

 

 

 

 

 

               absolute Value

78±19

83±17

92±17

99±9

103±14

<0.01

               Relation to Group 1

1

1.06

1.18

1.27

1.32

 

Mid ventricular

 

 

 

 

 

 

               absolute Value

70±13

75±7

81±6

87±9

94±8

<0.001

               Relation to Group 1

1

1.07

1.16

1.24

1.34

 

Apical

 

 

 

 

 

 

               absolute Value

27±12

38±7

44±6

47±10

50±8

<0.001

               Relation to Group 1

1

1.41

1.63

1.74

1.85

 

 

 

 

 

 

 

 

Area

 

 

 

 

 

 

Basal

 

 

 

 

 

 

               absolute Value

3246±731

3810±563

4359±646

4702±673

5416±751

<0.001

               Relation to Group 1

1

1.17

1.34

1.45

1.67

 

Mid ventricular

 

 

 

 

 

 

               absolute Value

2321±593

2843±522

3270±377

3642±645

4449±767

 

               Relation to Group 1

1

1.23

1.41

1.57

1.92

<0.001

Apical

 

 

 

 

 

 

               absolute Value

534±307

828±285

1055±220

1164±323

1551±488

<0.001

               Relation to Group 1

1

1.55

1.98

2.18

2.91

 

RV EF

 

 

 

 

 

 

Group

43.8±16.3

50.1±10.2

49±13.1

51.2±9.5

47.9±9.7

0.27

               Relation to Group 1

1

1.14

1.14

1.18

1.09

 




Figure 1.AI-Reconstruction of the RV with diameters in 4-, 2-Chamber and RVOT view

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