Three-dimensional echocardiography based evaluation of right ventricular remodeling in patients with pressure overload

Although 3D echocardiography (3DE) allows imaging of right ventricular (RV) morphology, regional RV remodeling has not been evaluated using 3DE. We developed a technique to quantify regional RV shape and tested its ability to characterize RV shape in normal subjects and in patients with RV pressure overload. Transthoracic 3DE images were acquired in 54 subjects (39 patients with pulmonary artery hypertension, PAH, and 15 normal controls, NL). 3D RV surfaces were reconstructed at end-diastole and end-systole (ED, ES) and analyzed using custom software to calculate 3D mean curvature of the inflow and outflow tracts, apex and body (both divided into free-wall and septum). Septal segments in NLs were characterized by concavity (curvature<;O) in ED and slight convexity (curvature>O) in ES. Conversely, the septum remained convex throughout the cardiac cycle in P AH. In the NL group, the body free-wall transitioned from a convex surface to a more flattened surface during contraction, while the convexity of the apex free-wall increased. In contrast, in PAH, both RV free-wall segments remained equally convex throughout the cardiac cycle. Curvature analysis using 3DE allows quantitative evaluation of RV remodeling, which could be used to track diferential changes in regional RV shape, as a way to assess disease progression or regression.