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Right ventricular (RV) dysfunction is a strong predictor of adverse clinical outcomes in patients with pulmonary hypertension (PH). The value of Three-dimensional speckle tracking echocardiography (3D-STE) for RV function assessment has not been well established. The purpose of our study was to comprehensively assess RV function in patients with PH using 3D-STE and investigate whether 3D-STE parameters was associated with clinical outcomes.
60 patients with PH and 25 normal controls were studied by both two-dimensional echo and 3D-STE. Standard two-dimensional measurements (RV–fractional area change, tricuspid annular plane systolic excursion) and tricuspid tissue Doppler annular velocities were obtained. RV regional and global longitudinal strain (LS), circumferential strain (CS), radial strain (RS) were calculated by 3D-STE. RV end diastolic volume, end systolic volume and ejection fraction were obtained from cardiac magnetic resonance imaging. Exercise capacity was evaluated by 6-minutes walking test.
Patients with PH had increased RV end-diastolic volume and end-systolic volume, and decreased ejection fraction compared with controls; RV global and regional LS, RS and CS were decreased in patients compared with controls. Patients with severe PH exhibited reduced RV global LS, RS and CS compared with patients with mild PH. RV global LS, RS and CS had superior correlations with cardiac magnetic resonance -derived RV ejection fraction, echocardiographically estimated hemodynamic parameters (pulmonary artery systolic pressure and pulmonary vascular resistance) and exercise capacity compared with conventional echo indices. RV GLS was an independent predictor of unfavorable clinical outcomes (Hazard ration: 0.849; 95% CI: 0.748 to 0.964; p=0.011).
patients with PH show decreased 3D-STE parameters that have better correlations with RV ejection fraction, hemodynamic parameters and exercise capacity than conventional echo indices, and provides prognostic information.