https://doi.org/10.1007/s00392-025-02625-4
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland
There is limited understanding of right heart failure in patients with chronic volume overload due to severe tricuspid regurgitation. Full-cycle cardiac computed tomography (CT) can effectively capture the complex geometry and function of the right ventricle (RV) throughout the entire cardiac cycle.
Methods and Results:
This study includes 133 patients (mean age 77±8; 61.7% female; mean RV ejection fraction (EF) 50.4±8.2%) who underwent high-resolution full-cycle cardiac CT for the analysis of valvular heart disease. AI-based algorithms were used for automated segmentation of the RV into 7 segments, as well as for quantitative analysis of diameter, segmental area, and volume in the 4-chamber, 2-chamber, and right ventricular outflow tract (RVOT) views for each segment. Subsequently, the cohort was divided into three groups based on ejection fraction (EF).
Compared to patients with a normally sized right ventricle and normal EF, those with reduced EF showed a significant increase in end-diastolic RV volume across all regions (p<0.001). The dilatation was most pronounced in the apical region of the ventricle. Additionally, the ratio between the 4-chamber and 2-chamber views increased significantly with the progression of RV dilatation (p<0.001). Furthermore, there was a decrease in relative contraction with increasing RVEDV, despite stable absolute contraction values (p<0.001).
Conclusion:
In the analysis of right ventricular geometry in patients with chronic RV volume overload, the greatest increase in relative dilatation was observed in the RV apex. With increasing dilatation, the geometric shape of the right ventricle changed from a triangular, conical to a spherical, cylindrical form. The increase in dilatation and relative contraction loss in the basal and mid-ventricular regions resulted in a decline in global RV ejection fraction in the context of tricuspid regurgitation.
AI-reconstruction of the right ventricle with depicted diameters in
4-chamber, 2-chamber, and RVOT views across 3 segments