Comparison of the capability of risk stratification evaluation between two‐ and three‐dimensional speckle‐tracking strain in pre‐capillary pulmonary hypertension

To investigate and compare the value of right ventricular longitudinal strain detected by two‐dimensional and three‐dimensional speckle‐tracking echocardiography in risk stratification evaluation in pre‐capillary pulmonary hypertension. We consecutively screened 66 patients diagnosed with pre‐capillary pulmonary hypertension in our center. According to the risk assessment recommended by 2015 European Society of Cardiology Guidelines, all participants were classified into low‐ and intermediate‐high‐risk group. Two‐dimensional and three‐dimensional strains were measured using off‐line softwares (GE EchoPAC version 201 and TomTec, 4D RV Function 2.0). Fifty‐seven pre‐capillary pulmonary hypertension patients (average 35 years old, 18 males and 39 females) were finally enrolled in our study, 32 (56.1%) were classified in low‐risk group, while 25 (43.9%) were in the intermediate‐high‐risk group. Clinical data associated with disease severity, such as N‐terminal pro‐brain natriuretic peptide (r = 0.574, P < 0.001), peak oxygen consumption (r = –0.484, P < 0.001), and 6‐min walking distance (r = –0.356, P = 0.008) were significantly correlated with two‐dimensional right ventricular longitudinal strain; while the correlations with three‐dimensional right ventricular longitudinal strain were weaker. Receiver operating characteristic curves for the detection of intermediate‐high risk stratification showed two‐dimensional right ventricular longitudinal strain had the best predictive capacity (area under curve, 0.82, 95% CI: 0.71–0.93, P < 0.001). Univariate and Multivariate Logistic regression analyses identified two‐dimensional right ventricular longitudinal strain as an independent predictor (OR: 1.42, 95% CI: 1.18–1.71, P < 0.001) of intermediate‐high risk stratification in this cohort of pre‐capillary pulmonary hypertension patients, the predictive capacity retained (OR: 1.45, 95% CI: 1.18–1.78, P < 0.001) after adjusted by age, gender, and body mass index, while three‐dimensional speckle‐tracking echocardiography parameters were not. In conclusion, when used for the detection of intermediate‐high risk stratification in pre‐capillary pulmonary hypertension, two‐dimensional right ventricular longitudinal strain was better than three‐dimensional right ventricular longitudinal strain.