Key result
Higher 3D RV circumferential strain is linked to ~11% fewer major events after tricuspid surgery.
Why the study?
Beyond conventional longitudinal indexes, nonlongitudinal right ventricular deformation may provide additional prognostic information in isolated tricuspid regurgitation.
Does preoperative 3D right ventricular circumferential strain (RV-CS) assessment predict all-cause mortality or heart failure hospitalization in adult patients undergoing isolated tricuspid valve surgery?
Cohort (n=251)
No
Does preoperative 3D right ventricular circumferential strain (RV-CS) assessment predict all-cause mortality or heart failure hospitalization in adult patients undergoing isolated tricuspid valve surgery?
Preoperative 3D right ventricular circumferential strain provides independent and incremental prognostic value for predicting mortality and heart failure hospitalization in patients undergoing isolated tricuspid valve surgery.
3D RV circumferential strain may aid preoperative prognostication in isolated tricuspid valve surgery; extends RV function data but remains hypothesis-generating.
BACKGROUND: Right ventricular (RV) function is closely associated with prognosis in isolated tricuspid regurgitation. Beyond conventional longitudinal indexes, nonlongitudinal RV deformation may provide additional prognostic information. OBJECTIVES: The authors aimed to evaluate whether 3-dimensional (3D) RV circumferential strain (RV-CS) provides incremental prognostic value in patients undergoing isolated tricuspid valve surgery (ITVS). METHODS: Patients scheduled for ITVS were prospectively enrolled and underwent 3D echocardiography 1 day before surgery. 3D RV longitudinal strain, CS, and area strain were derived using commercially available software. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization. RESULTS: From April 2018 to December 2024, 251 patients were enrolled; 171/251 (68.1%) were women, and the mean age was 57 ± 14 years. During a median follow-up of 495 days, 48/251 patients (19.1%) reached the primary endpoint. Baseline 3D right ventricular circumferential strain (3D RV-CS) was lower in patients with events than in those without events (P < 0.001) and showed modest but had the highest Harrell's C-index for adverse events discrimination (0.695; 95% CI: 0.618-0.774; P < 0.001) among all tested RV function parameters. Patients with impaired 3D RV-CS, defined as |3D RV-CS| < 14%, had lower 1-year event-free survival than those with preserved 3D RV-CS (54.2% vs 92.5%; log-rank P < 0.001). After multivariable adjustment, impaired 3D RV-CS remained independently associated with adverse events. Adding 3D RV-CS improved risk reclassification beyond European System for Cardiac Operative Risk Evaluation II, TRI-SCORE, and Society of Thoracic Surgeons score models. CONCLUSIONS: 3D RV-CS provides complementary prognostic information in patients undergoing ITVS and may improve preoperative risk stratification.
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Wu et al. (2026) conducted a cohort in Severe isolated tricuspid regurgitation (n=251). 3D right ventricular circumferential strain (3D RV-CS) vs. Lower 3D RV-CS was evaluated on Composite of all-cause mortality or heart failure hospitalization (HR 0.89, 95% CI 0.83-0.95, p=<0.001). Higher baseline 3D right ventricular circumferential strain was independently associated with a reduced risk of all-cause mortality or heart failure hospitalization (HR 0.89 per % increase) following isolated tricuspid valve surgery.
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