Artificial Intelligence-Based Analysis of Right Ventricular Work Is Associated with Outcomes after Transcatheter Tricuspid Valve Intervention.

AIMS: In tricuspid regurgitation (TR), conventional parameters of right ventricular (RV) function have limited prognostic utility. Our aim was to evaluate the prognostic value of RV pressure-strain-volume (PSV) analysis-derived work parameters in patients undergoing transcatheter tricuspid valve intervention (TTVI). METHODS: This multicenter retrospective observational study included 166 patients, of whom 140 (84.3%) underwent transcatheter tricuspid valve repair (TTVr) and 26 (15.7%) underwent transcatheter tricuspid valve replacement. A dedicated artificial intelligence-based software was used to reconstruct the RV pressure curve based on the peak RV systolic pressure and to fuse this curve with three-dimensional (3D) RV longitudinal strain and volumetric data to construct PSV loops and calculate corresponding RV work parameters. The outcomes of interest were TR progression after TTVr and the composite of heart failure (HF) hospitalization and all-cause death within 12 months after TTVI. RESULTS: Higher values of PSV-derived global wasted work (PSV-GWW) were associated with an increased risk of TR progression after TTVr (adjusted odds ratio per 100-unit increase = 1.108 [95% CI, 1.012-1.218], P = .028), whereas no significant associations were observed for other RV functional parameters. In the entire study cohort, both PSV-GWW (adjusted hazard ratio per 100-unit increase = 1.038 [95% CI, 1.002-1.075], P = .036) and 3D RV global longitudinal strain (adjusted hazard ratio per 1-unit decrease = 1.121 [95% CI, 1.029-1.221], P = .009) were independently associated with the composite endpoint. CONCLUSIONS: Pressure-strain-volume-GWW and 3D RV global longitudinal strain were independently associated with HF hospitalization and all-cause death within 12 months after TTVI. Pressure-strain-volume-GWW identified patients at increased risk of TR progression after TTVr.