Right ventricular adaptation in congenital heart disease: Does the type of right ventricular overload matter?

Figures

• 

  Single-beat pressure volume loop analysis was performed in patients with RV pressure and/or volume overload by combining RV pressures from right heart catheterization with RV volumes from cardiac MRI. Created in BioRender. Joosen, R. (2025) MRI, magnetic resonance imaging; RHC, right heart catheterization; RV, right ventricle.

• 

  Figure 1. Pressure–volume (PV) loops in different groups of right ventricular (RV) overload. Schematic results of RV PV loop analysis in groups of RV pressure overload, RV volume overload, and RV pressure and volume overload (combined). Arterial elastance (Ea), mainly a reflection of pulmonary vascular resistance, was calculated as RV systolic pressure/SV.20 End-systolic elastance (Ees), a load-independent measure of ventricular contractility, was calculated as (RV maximal isovolumic pressure – RV systolic pressure)/SV.19 The maximal isovolumic pressure of the RV (Piso), used to analyze RV contractility (Ees), was computed by sine wave extrapolation using RV pressure values recorded before maximal first derivative of pressure development over time (dP/dt) and after minimal dP/dt.19 Right ventricular–-to-pulmonary arterial coupling was calculated as Ees/Ea and represents the efficiency of energy transfer from the RV to the pulmonary vasculature RV. RV end-diastolic elastance (Eed), used to assess diastolic stiffness, was calculated as the slope of the end-diastolic PV relationship at end-diastole.21

• 

  Figure 2. Right ventricular (RV) contractility and diastolic stiffness corrected for RV relative wall thickness. Graph shows RV wall thickness corrected end-systolic elastance (Ees) as measure of RV contractility among the 3 groups of RV overload (A) and RV wall thickness corrected end-diastolic elastance (Eed) as measure of RV diastolic stiffness in the 3 RV overload groups (B).

• 

  Figure 3. Right ventricular adaptation in congenital heart disease. Created in BioRender. Joosen, R. (2025) https://BioRender.com/p94z452. PA, Pulmonary artery; RV, right ventricle