Abstract 238: Right Ventricular Remodeling and the Tricuspid Apparatus in Different Types of Pulmonary Hypertension: A Study With Real Time 3D Echocardiography
Introduction: Tricuspid regurgitation is an important determinant of prognosis in patients undergoing mitral valve intervention. Using a novel real time 3D echocardiographic tool, we examined the right ventricular remodeling and the tricuspid valve in two groups of patients.
Methods: Two matched groups of patients (55 with pulmonary arterial hypertension and 35 with degenerative mitral valve regurgitation and secondary pulmonary hypertension) were examined using 3D echocardiography and compared to a control group of healthy volunteers. Right ventricular volumes, ejection fraction, diameter of tricuspid annulus in end-diastole, regurgitant volume, tenting height and volume, as well as the angulation of each leaflet towards the annulus were measured. SPSS 13.0 was employed for statistical analysis. Reciever operating characteristic curves (ROC) were used to identify the values, which are more sensitive to predict an impaired right ventricle (EF < 55%).
Results: The right ventricle was significantly dilated and impaired in pulmonary arterial hypertension, compared to mitral valve disease (end-diastolic volume: 186±36 ml vs 103±14.3 ml, p<0.01) the anterior and posterior leaflet excursion was reduced in pulmonary arterial hypertension (anterior diastolic angulation: 58±3.6o, control: 85±2.5o(p<0.01). The regurgitant volume significantly correlated with the tenting volume (r=0.85, 41 ml (AUC: 0.921), tenting volume > 0.37 cm2 (AUC: 0.919), diastolic angulation: <72o (AUC: anterior: 0.812, posterior: 0.759).
Discussion: The tricuspid angulation model demonstrates anteroposterior dilatation of the right ventricle in significant pressure and volume loading conditions. In addition, a useful tool for the assessment of tricuspid regurgitation is tenting volume and the diastolic angulation of the anterior and posterior leaflets.