Key result
Combined 2D and 3D echocardiography accurately identifies severe pulmonary hypertension with an AUC of ~0.99.
Why the study?
The value of real-time three-dimensional echocardiography in evaluating right ventricular structure and function across different echocardiographic PASP strata in pulmonary hypertension patients was unclear.
Does combined 2D and real-time 3D echocardiography improve the evaluation of right ventricular structure and function in patients with pulmonary hypertension?
Observational (n=234)
Does combined 2D and real-time 3D echocardiography improve the evaluation of right ventricular structure and function in patients with pulmonary hypertension?
Effect estimate: AUC 0.956 and 0.998
Combined 2D and real-time 3D echocardiography provides high diagnostic discrimination for evaluating right ventricular remodeling and systolic dysfunction across different severity strata of pulmonary hypertension.
OBJECTIVE: To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular (RV) structure and function in patients with pulmonary hypertension (PH) across different echocardiographic pulmonary artery systolic pressure (PASP) strata. METHODS: A total of 150 patients with PH and 84 healthy controls were included. Patients with PH were stratified into mild, moderate and severe echocardiographic PASP strata. Conventional two-dimensional (2D) echocardiographic parameters and RT-3DE-derived RV parameters were compared among groups. Correlations between echocardiographic parameters and pulmonary pressure burden were analyzed. Cross-validated receiver operating characteristic analyses were performed to evaluate the diagnostic performance of 2D parameters, RT-3DE parameters and combined 2D plus RT-3DE models. RESULTS: PH etiologies included Group 1 pulmonary arterial hypertension (31.3%), Group 2 PH due to left heart disease (51.3%), Group 3 PH due to lung disease and/or hypoxia (11.3%), Group 4 PH associated with pulmonary artery obstruction (1.4%), and Group 5 PH with unclear and/or multifactorial mechanisms (4.7%). RV-TD, RV/LV ratio, RAEA, and RV-FW increased across echocardiographic PASP strata, whereas S', TAPSE, RVFAC, and RVEF decreased. RT-3DE-derived RV volume and functional parameters differed significantly among groups; within the PH cohort, RVEDV, RVESV, RVSV, and RV cardiac output increased across PASP strata, while RVEF progressively decreased. The combined 2D plus RT-3DE model showed high cross-validated discrimination for moderate-to-severe PH and severe PH, with AUCs of 0.956 and 0.998, respectively. CONCLUSION: Combined 2D echocardiography and RT-3DE provide complementary noninvasive information for evaluating RV remodeling and systolic dysfunction in patients with PH across different echocardiographic PASP strata.
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Liu et al. (2026) conducted an observational in Pulmonary hypertension (n=234). Real-time three-dimensional echocardiography (RT-3DE) vs. Conventional 2D echocardiography and healthy controls was evaluated on Diagnostic performance for moderate-to-severe PH and severe PH (AUC 0.956 and 0.998). A combined 2D and real-time 3D echocardiography model demonstrated high discrimination for moderate-to-severe and severe pulmonary hypertension, with AUCs of 0.956 and 0.998, respectively.
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