Tesi etd-10152025-084607 |
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Tipo di tesi
Tesi di specializzazione (4 anni)
Autore
GRASSINI, DARIO
URN
etd-10152025-084607
Titolo
Dynamic Cardiac CT Flow Analysis of Biventricular Function and Remodeling After Transcatheter Tricuspid Valve Replacement
Dipartimento
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Relatori
relatore Prof. De Carlo, Marco
Parole chiave
- right ventricle
- transcatheter tricuspid valve replacement
- TTVR
Data inizio appello
03/11/2025
Consultabilità
Non consultabile
Data di rilascio
03/11/2028
Riassunto
Background: Transcatheter tricuspid valve replacement (TTVR) is associated with biventricular remodeling, but the dynamic mechanisms underlying these changes remain poorly understood.
Objectives: To characterize biventricular remodeling after TTVR using dynamic flow indices derived from computed tomography (CT) volume–time curves.
Methods: TTVR patients underwent paired baseline and follow-up multiphasic ECG-gated cardiac CT scans with full-cycle coverage. Volume–time curves were reconstructed at 10% intervals to extract peak ejection rate (PER), peak filling rate (PFR), and their timing for both ventricles. Interventricular differences in systolic and diastolic flow rate and timing were assessed.
Results: Twenty-six patients (79 ± 6 years, 85% female) were included. At baseline, the RV was enlarged compared with the LV (EDV 289 ± 87 vs 79 ± 31 mL) and exhibited higher flow rates (PER 322 ± 128 vs 110 ± 55; PFR 360 ± 133 vs 118 ± 72 mL/cycle/m²), consistent with a hyperdynamic, volume-overloaded state. After TTVR, RV EDV, PER, and PFR decreased (206 ± 57 mL; 198 ± 82; 151 ± 72, all p<0.001), indicating unloading and attenuation of hyperdynamic flow. Conversely, LV stroke volume, PER, and PFR increased (48 ± 16 mL; 133 ± 55; 136 ± 54, all p<0.05), reflecting improved preload and systo-diastolic function. Interventricular flow differences were reduced (ΔPER –147; ΔPFR –228 mL/cycle/m², both p<0.001), while timing differences (ΔtPER, ΔtPFR) were no longer significant, demonstrating restoration of physiologic biventricular interaction.
Conclusions: TTVR resulted in favorable biventricular structural and functional adaptations, with RV unloading, LV recruitment and normalization of interventricular interaction.
Objectives: To characterize biventricular remodeling after TTVR using dynamic flow indices derived from computed tomography (CT) volume–time curves.
Methods: TTVR patients underwent paired baseline and follow-up multiphasic ECG-gated cardiac CT scans with full-cycle coverage. Volume–time curves were reconstructed at 10% intervals to extract peak ejection rate (PER), peak filling rate (PFR), and their timing for both ventricles. Interventricular differences in systolic and diastolic flow rate and timing were assessed.
Results: Twenty-six patients (79 ± 6 years, 85% female) were included. At baseline, the RV was enlarged compared with the LV (EDV 289 ± 87 vs 79 ± 31 mL) and exhibited higher flow rates (PER 322 ± 128 vs 110 ± 55; PFR 360 ± 133 vs 118 ± 72 mL/cycle/m²), consistent with a hyperdynamic, volume-overloaded state. After TTVR, RV EDV, PER, and PFR decreased (206 ± 57 mL; 198 ± 82; 151 ± 72, all p<0.001), indicating unloading and attenuation of hyperdynamic flow. Conversely, LV stroke volume, PER, and PFR increased (48 ± 16 mL; 133 ± 55; 136 ± 54, all p<0.05), reflecting improved preload and systo-diastolic function. Interventricular flow differences were reduced (ΔPER –147; ΔPFR –228 mL/cycle/m², both p<0.001), while timing differences (ΔtPER, ΔtPFR) were no longer significant, demonstrating restoration of physiologic biventricular interaction.
Conclusions: TTVR resulted in favorable biventricular structural and functional adaptations, with RV unloading, LV recruitment and normalization of interventricular interaction.
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