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Background: the right ventricle (RV) is a major determinant of prognosis in cardiac transplant recipient patients (CTp). Aim: To investigate RV morphology and function in CTp.Methods: 85 stable CTp (54 males; 58.3±10.8 years; 7.8±4.5 years after transplantation) and 40 healthy age- and sex-comparable controls underwent standard echocardiography, Tissue Doppler Imaging (TDI), two-dimensional strain (2DSE) and 3D echocardiography. RV measurements included: end-diastolic diameters at basal- (RVD1) and mid-cavity (RVD2); base-to-apex length (RVD3), tricuspid annular plane systolic excursion (TAPSE), TDI RV systolic peak velocity (Sm), global strain and 3D ejection fraction. Tricuspid regurgitation velocity was used to calculate the pulmonary artery systolic (PASP) pressure. Pulmonary artery vascular compliance (PVC) was estimated by left ventricular stroke volume/4 x (TRV2 – pulmonary regurgitation velocity2).Results: RV diameters were increased, while TAPSE and RV Sm were significantly lower in CTp. Conversely, both RV global longitudinal strain and 3DRVEF were not significantly impaired in CTp. In a subgroup of 30 CTp, a close correlation was observed between 3D and magnetic resonance assessment of RVEF (r = 0.89; p<0.0001). Both PASP and PVC were increased in CTp. By multivariable analysis, age (p<0.01) and PAC (p<0.001) were the only independent determinants of RV strain and ejection fraction in CTpConclusion: Despite the reduction of RV performance suggested by TAPSE and RV Sm, the increased RV diameters along with normal RV global strain and 3D RVEF support the hypothesis of geometrical rather than functional changes of RV in CTp.