Evolution of right ventricular contraction patterns of adult heart transplant recipients by three-dimensional echocardiography

Background The right ventricular contractile pattern is altered after heart transplantation (HT). This study aims to use three-dimensional echocardiography (3DE) to comprehensively assess right ventricular contractile pattern in HT patients. Methods In a cohort of 200 adult HT recipients, we serially assessed 3DE RV contraction patterns—including global (RVEF), longitudinal (LEF), radial (REF), and anteroposterior (AEF) ejection fractions—from the early post-operative period to 3 years. 50 HT patients were compared to matched healthy controls and open-heart surgery patients. Sex-specific reference values were derived. Results RV function parameters improved within the first year (all P < 0.05), then stabilized. At 1 year, HT recipients exhibited a distinct 3D contraction pattern compared to controls: attenuated longitudinal and anteroposterior function (LEF: 18.2% vs. 28.6%; AEF: 23.8% vs. 25.4%; P < 0.05) with compensatory enhanced radial contraction (REF: 29.8% vs. 24.6%; P < 0.05). Established reference ranges confirmed this phenotype. Cardiopulmonary bypass time were key determinants of this pattern. Conclusions HT recipients develop a unique, stabilized RV contraction pattern by one year, characterized by a shift from longitudinal to radial dominance.