P956A novel 3D echocardiographic model explains the different RV remodelling in different groups of pulmonary hypertensive patients: reconstruction with mathematical software

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Purpose: Using a novel 3D echocardiographic model, we examined the relationship between different right ventricular (RV) remodeling, based on the tricuspid leaflet excursion.Methods: Sixty-two patients with pulmonary arterial hypertension (PAH) (45 women, mean age 42.8 ± 12.5 years), 60 patients with pulmonary hypertension, secondary to severe degenerative mitral regurgitation (DMR) (26 women, mean age 52.6 ± 19 years) and 55 healthy subjects (H) (34 women, mean age 41.8 ± 9.2 years) were examined with 3D echocardiography. A full volume acquisition for volumes and a tricuspid zoom view were obtained, with Vivid 7 (GE). The geometrical excursion of the tricuspid leaflets was assessed with the calculation of the leaflets angulation towards the tricuspid annulus in end-diastole and end-systole (Tomtec, Echopac) RV end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (RV-EF) were measured with the method of disk summation. Matlab bioengineering software was employed for the equation which connects the tricuspid angles between PAH and DMR groups.Results: Overall, RV diastolic volumes (ml) were greater and RV EF (%) lower in PAH compared to DMR group (189.5 ± 49.2 ml vs. 110.2, p<0.001) and (32.5% vs. 67.8%, p<0.001) respectively. Amongst the two pulmonary hypertension groups, the tricuspid valve mobility was most restricted in the PAH group, and least restricted in the DMR group. The tenting volume (Tvol) was greater in PAH than in the DMR group (p<0.01). Most PAH patients (54.6%) had at least moderate tricuspid regurgitation. Conversely, MR patients (85%) only had mild tricuspid regurgitation. There was no correlation between RV systolic pressures and RV EF or Tvol.Matlab reconstruction for the tricuspid angulation demonstrated the equation which connects the tricuspid leaflet angulation for each disease. It seems that RV dilates towards the anteroposterior direction in an symmetrical way.Conclusions: RV remodeling is different in PAH, DMR and normal subjects, as demonstrated with 3D echocardiography. There is an equation which explains the RV anteroposterior dilatation in PAH and DMR groups.

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