Changes in right ventricular function on three-dimensional speckle tracking echocardiography after transcatheter pulmonary valve replacement.

Background: Pulmonary regurgitation (PR) is common after tetralogy of Fallot (TOF) repair and closely associated with adverse outcomes. Transcatheter pulmonary valve replacement (TPVR) is a novel treatment for severe PR or mixed pulmonary stenosis (PS) and regurgitation. The aim of this study was to evaluate the changes in right ventricular (RV) function in patients after TPVR on two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography and to identify the predictors of RV function and New York Heart Association (NYHA) functional class at 6 months after TPVR. Methods: Twenty-one patients who underwent TPVR were prospectively enrolled. 2D and 3D RV free wall longitudinal strain (2D-RVFWLS and 3D-RVFWLS) were obtained by 2D and 3D speckle tracking echocardiography, respectively, before TPVR and at 1 week and 6 months after TPVR. Results: The 2D-RVFWLS and 3D-RVFWLS at 1 week after TPVR were lower than those before TPVR and improved to the baseline levels at 6 months after TPVR (P<0.05). Preoperative 2D-RVFWLS and 3D-RVFWLS were independent predictors of RV function (β=0.415 and β=0.618; P<0.05) and NYHA functional class (β=0.636 and β=0.674; P<0.05) at 6 months after TPVR. In predicting RV function at 6 months after TPVR, the model with 3D-RVFWLS (R2=0.606; P=0.008) was not inferior to that with 2D-RVFWLS (R2=0.424; P=0.034). Moreover, in predicting NYHA functional class at 6 months after TPVR, the model with 3D-RVFWLS (R2=0.771; P<0.001) was similar to that with 2D-RVFWLS (R2=0.737; P<0.001). Conclusions: 2D-RVFWLS and 3D-RVFWLS decreased 1 week after TPVR and returned to the baseline levels at 6-month follow-up. Preoperative 2D-RVFWLS and 3D-RVFWLS are independent predictors of RV function and NYHA functional class at 6 months after TPVR.