Abstract 14799: In-vitro Contractile and Echocardiographic Right Ventricular Function in Patients with Tricuspid Regurgitation
Objective: Right ventricular (RV) dysfunction is often cited as a reason not to intervene in patients with tricuspid regurgitation (TR). We compared quantitative echocardiographic measures of preoperative RV function, and in vitro function of RV muscle harvested during cardiac surgery between mild and severe TR patients.
Methods: 43 cardiac surgical patients (19 with TR grade 3+/4+ and 24 with grade 0/1+/2+) underwent trabecular harvest from RV free wall through a right atriotomy during valve repair or replacement. Preoperative echocardiographic RV measurements-- tricuspid anular plane systolic excursion (TAPSE), myocardial performance index (MPI), speckle-derived global longitudinal systolic strain (Strain) and strain rate (SR)--were correlated with isometric contraction of 2 muscle trabeculae, 1-2 mm thick 8-10 mm long. At length of maximal tension development, we measured resting tension, developed tension, and developed tension after isoproterenol administration.
Results: Correlations were found among echocardiographic measures of RV function: TAPSE with Strain (r= -0.65) (left Fig.), MPI with Strain (r= 0.48), TAPSE with SR (r= -0.47). No strong correlations were seen between isometric contractile variables and these echocardiographic measures. No significant differences in in-vitro muscle contractile function were seen between 0/1+/2+ and 3+/4+ TR patients (right Fig.).
Conclusions: TAPSE, MPI and deformation parameters are correlated with each other but not with contractile function of RV muscle in vitro. The preservation of trabecular function in patients with 3+/4+ TR suggests recovery may be possible with normalization of loading conditions. Impairment of noninvasive systolic parameters in TR does not signify irreversible RV dysfunction.
- © 2012 by American Heart Association, Inc.