3D echocardiography identified higher RV end-diastolic volume (191 vs 151 mL, P=0.001) and reduced free-wall strain in non-low-risk versus low-risk PAH and CTEPH patients.
Cross-Sectional (n=49)
Can 3D echocardiography and RV free-wall strain discriminate between clinical risk groups in patients with PAH or CTEPH?
3D echocardiographic RV volumes and free-wall strain can effectively discriminate clinical risk profiles in PAH and CTEPH, offering a practical alternative to cMRI.
Absolute Event Rate: 191% vs 151%
p-value: p=0.001
Abstract Aims Right ventricular (RV) dysfunction is a key prognostic factor in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Evaluation by cardiac magnetic resonance imaging (cMRI) is preferred, but it is expensive and time-consuming. We therefore tested whether semiautomated, three-dimensional transthoracic echocardiography and RV free-wall strain could discriminate between clinical risk groups. Methods and results We studied 49 patients with PAH or CTEPH. Study participants underwent cMRI and 2D and 3D echocardiography with the assessment of measures of RV size and function. Patients were categorized into low and non–low clinical risk groups based on a modified version of the ESC/ERS four-strata risk-assessment model. Among the non–low-risk patients, cMRI found an elevated RV end-diastolic and end-systolic volume, and a reduced RV ejection fraction, after adjustment for disease subtype, age, sex, BMI, and smoking status, compared to the low-risk group; 3D echocardiography confirmed a higher end-diastolic and end-systolic volume in the non-low-risk group (191 ± 61 mL vs. 151 ± 44 mL, P = 0.001 and 121 ± 42 mL vs. 97 ± 38 mL, P = 0.007), and free-wall strain was reduced (−15.0 ± 4.1% vs. −17.3 ± 3.4%, P = 0.029). No significant difference was observed in RV ejection fraction between groups (37.2 ± 6.4% vs. 38.7 ± 7.7%, P = 0.223). Traditional 2D echocardiographic measures of RV function, including tricuspid annular plane systolic excursion and RV fractional area change, did not differ between the groups. Conclusion Larger 3D-echocardiographic RV volumes and reduced free-wall strain were associated with a worse clinical risk profile in PAH and CTEPH, whereas RV ejection fraction and traditional 2D measures were not. These parameters offer a practical alternative to cMRI for evaluating RV remodeling.
Amiri et al. (Thu,) conducted a cross-sectional in Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) (n=49). 3D echocardiography and RV free-wall strain analysis vs. Traditional 2D echocardiography was evaluated on Right ventricular end-diastolic volume (mL) in non-low-risk vs low-risk groups (p=0.001). 3D echocardiography identified higher RV end-diastolic volume (191 vs 151 mL, P=0.001) and reduced free-wall strain in non-low-risk versus low-risk PAH and CTEPH patients.