RIGHT VENTRICULAR FUNCTION AND PROGNOSIS: MOVING BEYOND CONVENTIONAL ECHOCARDIOGRAPHY
Tolvaj Máté
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Városmajori Klinikák Tanterme
2026-02-10 16:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Kovács Attila
Dr. Tárnoki Ádám
Dr. Jenei Csaba
Dr. Benyó Zoltán
Dr. Benke Kálmán
Dr. Varga Albert
The right ventricle (RV), historically regarded as the "forgotten chamber," has gained increasing recognition for its crucial prognostic role in various cardiovascular pathologies. This doctoral thesis comprehensively evaluates RV systolic function using advanced echocardiographic modalities, emphasizing three-dimensional echocardiography (3DE) and strain-based techniques. The work is structured around three major studies that collectively interrogate the limitations of conventional RV function metrics, establish the prognostic value of 3DE-derived right ventricular ejection fraction (RVEF), and explore the incremental utility of RV deformation parameters, particularly global circumferential strain (GCS). In the first study, a heterogeneous cohort of patients undergoing diverse cardiovascular interventions was assessed to determine whether 3DE-derived RVEF offers incremental prognostic information beyond traditional echocardiographic indices. The findings demonstrated that RVEF was independently associated with two-year all-cause mortality and exhibited superior discriminatory power compared to parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free wall longitudinal strain (FWLS), underscoring the value of volumetric RV assessment in refined risk stratification. The second study focused on the discordance between conventional RV function parameters and 3DE-derived RVEF in a large two-center population. A significant degree of reclassification was observed when RVEF served as the reference standard, with notable differences across distinct cardiac pathologies. Importantly, reclassification based on RVEF was strongly associated with divergent clinical outcomes, highlighting the limitations of isolated conventional parameters and advocating for a multiparametric approach where 3DE is unavailable. The third study assessed the prognostic implications of RV strain mechanics in patients with left-sided cardiac disease. Using 3DE-derived GLS and GCS, the study demonstrated that RVGCS emerged as an independent predictor of all-cause mortality, outperforming even left ventricular (LV) GLS in multivariable models. Stratification based on combined LV and RV strain parameters revealed that patients with impaired RVGCS, regardless of LV strain status, faced markedly worse survival rates. Collectively, this thesis emphasizes the inadequacy of relying solely on traditional echocardiographic measures of RV function and substantiates the pivotal role of 3DE-derived metrics, especially RVEF and RVGCS, in contemporary cardiac risk assessment. These findings advocate for the integration of advanced RV functional parameters into routine clinical practice to enable more precise prognostication and personalized therapeutic strategies.
