Worsening right ventricular function by 3D RVEF increased risk of mortality and heart failure (normal vs mild HR 2.628; 95% CI 1.571-4.399), whereas conventional parameters showed high discordance.
Cohort (n=750)
Yes
Do conventional echocardiographic parameters (TAPSE, FAC, FWLS) provide consistent severity grading and prognostic value for right ventricular dysfunction compared to 3D echocardiography-derived ejection fraction?
Conventional echocardiographic parameters show significant discordance with 3D RVEF in grading RV dysfunction and fail to provide consistent risk stratification, highlighting the need for a multiparametric approach.
Hazard Ratio: 2.628 (95% CI 1.571–4.399)
p-value: p=<0.001
Abstract Introduction The 2025 American Society of Echocardiography guidelines on the right heart introduce severity grading for right ventricular (RV) dysfunction across individual functional parameters, including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), free-wall longitudinal strain (FWLS), and 3D echocardiography-derived RV ejection fraction (RVEF). However, isolated assessment using individual parameters may result in inconsistent grading, and the relationship between severity grades and adverse clinical outcomes remains to be validated. Purpose Accordingly, we aimed to investigate the prognostic value and discordance among severity grades of RV dysfunction as assessed by TAPSE, FAC, FWLS, and RVEF. Methods We analyzed 2D and 3D echocardiographic data from two centers, including 750 patients followed for the composite primary endpoint of all-cause mortality and heart failure hospitalization. The severity of RV dysfunction was classified using the guideline-recommended cutoff values for TAPSE, FAC, and FWLS, and these classifications were compared with the severity grades based on RVEF. Results Over a median follow-up of 3.2 years, 183 patients (24%) met the primary endpoint. Kaplan-Meier analysis showed that worsening RV function categories by RVEF was associated with progressively increased risk of adverse outcomes, significant between normal vs. mild (HR: 2.628 95% CI: 1.571 – 4.399, log-rank p0.001), and mild vs. moderate groups (HR: 1.833 95% CI: 1.106 – 3.039, p=0.019), but not between moderate vs. severe (Figure 1A). TAPSE-based classification showed a nearly twofold higher risk across all dysfunction groups compared to normal, but without significant differences between the dysfunction groups (Figure 1B). FAC identified a significant risk difference between adjacent severity categories only for the mild vs. moderate group (HR: 2.054 95% CI: 1.279 – 3.297, p0.001) (Figure 2A). FWLS showed higher risk in normal vs. mild (HR: 2.241 95% CI: 1.412 – 3.557, p0.001) and mild vs. moderate groups (HR: 1.668 95% CI: 0.957 – 2.908, p=0.045) (Figure 2B). Concordance between TAPSE and RVEF-based classification was low, with agreement rates of 17%, 14%, and 18% for mild, moderate, and severe dysfunction, respectively. FAC showed similarly low agreement with RVEF, particularly for mild (16%) and moderate (21%) dysfunction, improving only for severe dysfunction (52%). FWLS demonstrated the highest, though modest, concordance with RVEF — 27% for mild, 30% for moderate, and 83% for severe dysfunction. Conclusion Significant discordance was observed between conventional echocardiographic parameters and RVEF in grading RV systolic dysfunction. None of the individual RV functional parameters provided consistent risk stratification, highlighting their limited prognostic utility when used in isolation. These findings emphasize the need for a multiparametric approach to RV function assessment.Figure 1 Figure 2
Tolvaj et al. (Thu,) conducted a cohort in Right ventricular dysfunction (n=750). Right ventricular dysfunction severity grading by 3D RVEF vs. Normal right ventricular function was evaluated on Composite of all-cause mortality and heart failure hospitalization (HR 2.628, 95% CI 1.571-4.399, p=<0.001). Worsening right ventricular function by 3D RVEF increased risk of mortality and heart failure (normal vs mild HR 2.628; 95% CI 1.571-4.399), whereas conventional parameters showed high discordance.