Tricuspid Annular Geometry as a Marker of Right Ventricular Function and Remodeling

OBJECTIVE To determine whether dynamic 3-dimensional (3D) tricuspid valve (TV) indices are associated with right ventricular (RV)-pulmonary artery (PA) coupling and may serve as surrogate markers of RV remodeling. DESIGN Prospective observational cohort study. SETTING Operating rooms at a single academic medical center. PARTICIPANTS Fifty-three adult patients undergoing cardiac surgery with cardiopulmonary bypass who had undergone intraoperative 3D transesophageal echocardiography and clinically indicated PA catheterization. INTERVENTIONS No study-specific therapeutic intervention was performed. Participants underwent standardized intraoperative hemodynamic assessment and offline 3D TV quantification. MEASUREMENTS AND MAIN RESULTS RV-PA coupling was quantified using single-beat pressure-volume methods; impaired coupling was defined as an end-systolic elastance (Ees) to effective arterial elastance (Ea) ratio <0.8. The 3D tricuspid analysis measured annular geometry, annular dynamism, and leaflet tethering indices. Seventeen patients (32%) had impaired coupling. Compared to patients with preserved coupling, those with impaired coupling had lower annulus area change (mean, 11.9% ± 5.2% v 15.8% ± 5.9%; p = 0.025) and greater body surface area-indexed tenting volume (mean, 1.04 ± 0.60 mL/m² v 0.72 ± 0.48 mL/m²; p = 0.044). Annulus area change correlated positively with Ees/Ea (R² = 0.96; p < 0.001), whereas indexed tenting volume correlated inversely (R² = 0.95; p < 0.001). Annulus area change <11% and indexed tenting volume >0.7118 mL/m² identified impaired coupling with moderate discrimination. CONCLUSIONS Reduced tricuspid annular dynamism and increased leaflet tenting are associated with impaired RV-PA coupling. Dynamic 3D TV metrics may provide surrogate markers of early RV remodeling.