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Background Right ventricle (RV) remodeling is a marker of advanced disease and impaired prognosis in heart failure reduced ejection fraction (HFrEF) patients [1]. The assessment of RV remodeling is limited with standard echocardiography. Three-dimensional speckle-tracking echocardiography (3DSTE), with advanced post-processing, allows for RV shape and regional function assessment, potentially providing additional information [2]. Purpose 1) to describe global and regional RV shape and function in a HFrEF cohort of patients; 2) to define RV remodeling phenotypes according with pulmonary haemodynamics; 3) to test the prognostic significance of RV shape and functional parameters. Methods 81 HFrEF patients were prospectively enrolled and followed-up (median time 760 days) for the composite end-point of death, heart failure hospitalization, heart transplant and left ventricular assist device implantation. They received standard 3DSTE evaluation, consisting of end-diastolic volume index (EDVi), end-systolic (ES) volume index (ESVi) and ejection fraction (EF) measurement via commercial software (TomTec Imaging Systems GmbH, Germany). Advanced post-processing provided RV free-wall and septal mean curvatures (Km) and minimum principal strain (MPS) [3] quantification. A subgroup of 40 subjects underwent right heart catheterization (RHC) and were classified in: group A – no pulmonary hypertension (PH) (n=15), group B – PH but normal pulmonary vascular resistance (PVR) (n=15) and group C – PH and increased PVR (n=10). Roc curves were used to identify RV parameters able to discriminate subjects belonging to group A. Prognostic significance of RV remodeling parameters was tested for the composite end-point. Results Patients who did receive RHC showed lower ES free-wall Km (0.052 vs 0.058 mm-1, p−22.4% (threshold discriminating normal pulmonary hemodynamic) resulted statistically associated with prognosis (Fig. 2). Conclusion In HFrEF patients, RV remodeling is progressively associated with unfavourable pulmonary haemodynamic, with a free-wall negative remodeling (abnormal curvature) resulting in loss of systolic function. RV free-wall function is tightly associated with the development of PH. 3DSTE indexes of RV global and regional function showed prognostic significance together with MR coexistence. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): IRCCS Policlinico San Donato is a clinical research hospital partially funded by the Italian Ministry of Health Figure 1. End-systolic MPS distributionFigure 2. Kaplan-Meier survival analysis

Background The role of interventricular (IV) septum in mediating the mechanical interaction between the two ventricles is well recognized. This interaction is promoted by several structural and hemodynamic determinants. We aimed at assessing the geometrical RV changes in patients with pulmonary hypertension (PH) compared to normal, evaluating RV curvature at rest and during stress testing addressing the specific role of pressure-induced changes in IV septum curvature. Methods Thirty-four subjects (15 controls; 19 PH patients) underwent RV real-time 3D full volume acquisition at rest and during exercise-echo. The 3D data were analysed off-line using the 4D RV TomTec software. The 3D mesh of the RV model was post-processed using a custom developed software. The value of mean regional curvature was assessed for the interventricular septum (IVS) at end-diastole (ED) and at end systole (ES). Results In controls the IVS curvature, assessed at end-diastole (ED) and end-systole (ES), was significantly (p Conclusions These data provide new perspectives on how the interventricular septum morphology adapts during exercise in PH patients vs controls. Changes in IVS curvature are linearly related to pulmonary pressure changes and occur with different slope (rest-exercise) in PH vs controls.