A Multicenter Study on the Normal Reference Range and Clinical Significance of the Right Atrioventricular Coupling Index Assessed by Artificial Intelligence-Based Three-Dimensional Echocardiography

Prior treatment

• Concurrent liver or renal disease
• Concurrent malignancy

Other illness

• Clinically significant cardiac valve regurgitation (≥ mild severity)
• Respiratory diseases: acute or chronic respiratory disorders
• Endocrine diseases: thyroid disease, diabetes mellitus, hyperaldosteronism, pheochromocytoma, etc.
• Other systemic diseases: anemia, malignancy, connective tissue disease, large artery/peripheral vascular diseases (aortic dilation, aortic dissection, coarctation of the aorta, Takayasu arteritis, atherosclerosis), etc.
• Poor-quality ultrasound images that cannot support parameter measurement and analysis
  • Pulmonary Hypertension Group
• Unable to complete right heart catheterization or pressure-volume loop assessment
• Pericardial disease or arrhythmias (e.g., atrial fibrillation) that severely impair right heart function evaluation
• History of surgical procedures such as pulmonary endarterectomy or balloon pulmonary angioplasty
  • Heart Failure Group
• 1.Complicated with significant valvular heart disease (e.g., severe mitral regurgitation, severe tricuspid regurgitation, etc.)
• Pericardial disease or arrhythmias (persistent atrial fibrillation) that interfere with measurements
• Congenital heart disease or residual lesions after surgical correction
  • Atrial Septal Defect Group
• 1.Complicated with other complex congenital heart diseases.

Lab values

• Abnormal liver function (alanine transaminase \> 2× upper limit of normal), abnormal renal function (elevated creatinine beyond normal range), or dyslipidemia (elevated triglycerides, total cholesterol, low-density lipoprotein, or high-density lipoprotein)
• Complicated with significant left heart disease (left ventricular ejection fraction \[LVEF\] \< 50%, significant mitral valve disease)

Other

• Participants will be excluded if they meet any of the following criteria:
• Pregnant or lactating women
• Professional athletes
• Patients will be excluded if they meet any of the following criteria:
• Poor-quality images that prevent accurate measurement of right atrial or right ventricular parameters
• Patients will be excluded if they meet any of the following criteria:
• Tricuspid Regurgitation Group
• Patients will be excluded if they meet any of the following criteria:

• Participants must meet all of the following criteria to be enrolled:
  • Of Han Chinese ethnicity
  • Aged 18-79 years
  • Normal blood pressure (\< 140/90 mmHg)
  • Normal fasting blood glucose
  • Normal blood lipid levels (triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein)
  • Normal complete blood count results (hemoglobin concentration, white blood cell count, red blood cell count, platelet count)
  • Normal liver and renal function (alanine transaminase \< 2× upper limit of normal; normal creatinine and blood urea nitrogen)
  • Normal electrocardiogram results (occasional atrial premature beats may be enrolled at the investigator's discretion)
  • No structural heart disease and normal cardiac function confirmed by echocardiography
• Patients must meet all of the following criteria to be enrolled:
• Aged 18-79 years
• Confirmed diagnosis via right heart catheterization: mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg, in accordance with the 2022 ESC/ERS guidelines
• Patients must meet all of the following criteria to be enrolled:
• Aged 18-79 years
• Meets the 2022 AHA/ACC/HFSA diagnostic criteria for heart failure
• Patients must meet all of the following criteria to be enrolled:
• Moderate or severe primary or secondary tricuspid regurgitation confirmed by echocardiography
• Aged 18-79 years
• Patients must meet all of the following criteria to be enrolled:
• Secundum atrial septal defect confirmed by echocardiography or transesophageal echocardiography
• Patients who have not undergone closure or surgical correction, or stable patients with \> 3 months postoperatively
• Aged 18-79 years

Criteria the registry did not label

• Healthy Adults Group