Right Ventricular Function Assessed by Speckle Tracking Echocardiography in Patients Undergoing Transcatheter Pulmonary Valve Replacement

The effect of pulmonary valve replacement (PVR) on right ventricular (RV) function remains unclear. Cardiac magnetic resonance (CMR) is the gold standard for RV assessment but has practical limitations. Speckle tracking echocardiography (STE) may offer an alternative for evaluating RV systolic function. This study used STE to assess changes in RV systolic strain and right atrial (RA) strain following PVR. STE parameters including RV free-wall longitudinal strain (RVFWSL), RV four-chamber strain (RV4CSL), regional basal, mid-ventricular, apical RV strain, RA reservoir and contraction strain were assessed in 50 patients who underwent TPVR at pre-, post-operative day 1 and at six-month follow-up. RV systolic strain significantly improved after TPVR. RVFWSL increased from - 20.3 ± 5.1% at baseline to - 23.3 ± 5.2% (P < 0.001), and RV4CSL improved from - 18.5 ± 4.1% to - 21.3 ± 4.1% (P < 0.001). Regional RV strain also significantly improved at the basal, mid-cavity and apical levels (- 18.1 ± 4.3% to - 21.4 ± 5.5%, P < 0.001). RA reservoir and contraction strain, did not change significantly. Patients with RV end-systolic volume index < 80 mL/m2 demonstrated greater improvement in RV4CSL than those with larger RV systolic volumes. Transcatheter PVR is associated with significant improvement in RV systolic strain at six months, with no significant change observed on postoperative day 1. This delayed recovery highlights the importance of longitudinal assessment, for which STE may serve as a feasible complementary tool to CMR in guiding follow-up imaging.