Decoding right ventricular geometry: novel 3D echocardiography-derived global shape analysis across health and disease states

Aims While pre-defined reference shapes have been used to assess morphological changes in the left ventricle, standardized methods for evaluating right ventricular (RV) remodelling are lacking. This study aimed to develop and test a new 3D echocardiography (3DE)-based method for quantifying RV shape in a large cohort of healthy individuals and across various disease states. Methods 3DE-derived RV mesh models were reconstructed in 1043 healthy subjects from the World Alliance of Societies of and results Echocardiography (WASE) study and in 581 patients with severe aortic stenosis, heart failure with reduced ejection fraction (HFrEF), post-heart transplantation, severe primary mitral regurgitation (MR), atrial secondary tricuspid regurgitation (A-STR), tetralogy of Fallot (TOF), and pulmonary hypertension (PH). To assess global RV shape, hemi-sphericity volume ratio (HSVR) and hemi-conicity angle (HCA) were calculated, where a higher HSVR and a more acute HCA reflect more spherical and conical shapes, respectively. In the WASE population, females had more spherical RVs, whereas males had more conical RVs (P = 0.028). Considering age, younger females had more conical RVs, while older individuals in both sexes showed spherical remodelling (P < 0.05). Comparing disease groups with WASE controls, MR, HFrEF, and A-STR patients had more spherical RVs compared with controls (both P < 0.001), while PH and TOF patients showed conical remodelling (both P < 0.001). In A-STR, a more conical remodelling was associated with adverse clinical outcomes. Conclusion The proposed 3DE-based method comprehensively characterizes RV geometry, demonstrating demographic variation in healthy individuals and disease-specific alterations in patients, with important prognostic implications.