Key result
Multimodality imaging comprehensively assesses RV function to guide intervention timing in severe TR.
Why the study?
Evaluating right ventricular function in severe tricuspid regurgitation is challenging using conventional echocardiography, making multimodality imaging critical for detecting dysfunction and guiding intervention timing.
Advanced multimodality imaging techniques are essential for accurately assessing right ventricular function in severe tricuspid regurgitation, aiding in patient selection and timing for interventions.
Supports multimodality imaging for RV assessment in severe TR; leaves open prospective validation before guiding intervention timing.
Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank-Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR.
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Melillo et al. (2024) conducted a review in Severe tricuspid regurgitation. Multimodality imaging was evaluated. Multimodality imaging, including 3D echocardiography, CMR, and CCT, provides a comprehensive assessment of right ventricular function to guide intervention timing in severe tricuspid regurgitation.
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