Why the study?
High-end echocardiography costs require evaluating the incremental value of 3D volumes and myocardial strain, whose collective prognostic impact in all-comers clinical populations remains underexplored beyond specific pathologies.
Does integrating advanced echocardiographic metrics (3D volumes and myocardial strain) with standard 2D measurements improve prognostic prediction of heart failure hospitalization or death in a real-world clinical population?
Cohort (n=494)
Does integrating advanced echocardiographic metrics (3D volumes and myocardial strain) with standard 2D measurements improve prognostic prediction of heart failure hospitalization or death in a real-world clinical population?
Integrating 3D volumes and myocardial strain across all cardiac chambers into routine echocardiography significantly improves prognostic stratification for death and heart failure hospitalization beyond conventional 2D assessment in an all-comers clinical population.
Background High-end echocardiography costs necessitate evaluating the incremental value of advanced metrics, such as 3D volumes and myocardial strain. While established in specific pathologies, their collective prognostic impact in "all-comers" clinical populations remains underexplored. Purpose To evaluate the incremental prognostic value of integrating myocardial strain and 3D volumes with standard 2D measurements in a real-world clinical setting. Methods We prospectively enrolled 494 consecutive patients (2021–2022) referred for diverse indications, primarily coronary artery disease (22.9%) and primary prevention (21.5%). Patients underwent 2D/3D assessment of left ventricular (LV), right ventricular (RV), and left atrial (LA) volumes and function, including ejection fraction (EF), global longitudinal strain (GLS), RV free wall strain (RVFWs), and LA reservoir strain (LASr). The primary composite endpoint was heart failure hospitalization or death. Incremental value was assessed using nested Cox regression models. Results During a 3-year median follow-up, 72 patients (14.6%) reached the endpoint. For the LV, adding advanced parameters (3D-LVEF and GLS) to the 2D clinical model significantly improved risk prediction (Δχ 2 = 32.55, p < 0.001; C-statistic: 0.811 to 0.848). For the RV, advanced metrics (3D-RVEF and RVFWs) provided substantial gain beyond standard assessment (Δχ 2 = 17.40, p < 0.001; C-statistic: 0.782 to 0.806). Similarly, for the LA, advanced metrics (3D-LAVi and LASr) further enhanced the model beyond standard parameters (Δχ 2 = 11.86, p = 0.003; C-statistic: 0.815 to 0.834). Conclusion Advanced echocardiographic techniques consistently enhance prognostic stratification beyond conventional 2D assessment across all cardiac chambers in real-world clinical practice.
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Heilbron et al. (2026) conducted a cohort in Diverse clinical indications including coronary artery disease (22.9%) and primary prevention (21.5%) (n=494). Advanced echocardiographic assessment (3D volumes and myocardial strain: 3D-LVEF, GLS, 3D-RVEF, RVFWs, 3D-LAVi, LASr) vs. Standard 2D echocardiographic clinical assessment was evaluated on Heart failure hospitalization or death (C-statistic 0.848 vs 0.811 (LV model, Δχ2 = 32.55), p=<0.001).
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