Key result
Changes in 3D right ventricular area strain over 6 months, combined with WHO class and BNP, strongly predicted death or transplant in pulmonary hypertension (HR 11.5; 95% CI 1.55-86.06).
Why the study?
It was hypothesized that changes in RV function, especially area strain, could provide incremental prognostic information over baseline data alone in pulmonary hypertension patients.
Does the change in 3D right ventricular area strain over 6 months predict death or transplant in patients with pulmonary hypertension?
Cohort (n=95)
Does the change in 3D right ventricular area strain over 6 months predict death or transplant in patients with pulmonary hypertension?
Effect estimate: HR 11.5 (95% CI 1.55-86.06)
p-value: p=<0.001
Changes in 3D right ventricular area strain over 6 months provide incremental prognostic value for predicting death or transplant in patients with pulmonary hypertension.
May support serial 3D RV strain monitoring in PH; leaves open prospective validation for routine risk stratification.
AIMS: Outcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function and remodelling. We hypothesized that changes in RV function and especially area strain (AS) could provide incremental prognostic information compared to the use of baseline data only. We therefore aimed to assess RV function changes between baseline and 6-month follow-up and evaluate their prognostic value for PH patients using 3D echocardiography. METHODS AND RESULTS: Ninety-five PH patients underwent a prospective longitudinal study including ESC/ERS guidelines prognostic assessment and 3D RV echocardiographic imaging at baseline and 6-month follow-up. Semi-automatic software tracked the RV along the cycle, and its output was post-processed to extract 3D deformation patterns. Over a median follow-up of 24.8 (22.1-25.7) months, 21 patients died from PH or were transplanted. Improvements in RV global AS were associated with stable or improving clinical condition as well as survival free from transplant (P < 0.001). The 3D deformation patterns confirmed that the most significant regional changes occurred within the septum. RV global AS change over 6-month by +3.5% identifies patients with a 3.7-fold increased risk of death or transplant. On multivariate COX analysis, changes in WHO class, BNP, and RV global AS were independent predictors of outcomes. Besides, the combination of these three parameters was of special interest to identify high-risk patients [HR 11.5 (1.55-86.06)]. CONCLUSION: Changes in RV function and especially changes in 3D RV AS are of prognostic importance. Our study underlines that assessing such changes from baseline to follow-up is of additional prognostic value for PH patients. CLINICAL TRIAL REGISTRATION: http://clinicaltrials.gov/ct2/show/NCT02799979.
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Moceri et al. (2021) conducted a cohort in Pulmonary hypertension (n=95). 3D right ventricular area strain (AS) assessment vs. Baseline data only was evaluated on Death from pulmonary hypertension or transplant (HR 11.5, 95% CI 1.55-86.06, p=<0.001). Changes in 3D right ventricular area strain over 6 months, combined with WHO class and BNP, strongly predicted death or transplant in pulmonary hypertension (HR 11.5; 95% CI 1.55-86.06).
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