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The value of three-dimensional echocardiography in risk stratification in pulmonary arterial hypertension: a cross-sectional study

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Abstract

To explore the value of right ventricular (RV) parameters detected by three-dimensional echocardiography (3DE) in risk stratification in pulmonary arterial hypertension (PAH) patients. We prospectively recruited 130 pulmonary hypertension patients from National Center for Cardiovascular Diseases, Fuwai Hospital. Each participant was performed a transthoracic echocardiography and 3DE parameters were measured using an off-line software (4D RV Function 2.0, TomTec). Patients were classified into low, intermediate-high risk group based on 2015 ESC Guidelines. A total of 91 PAH patients (34 ± 12 years old, 25 males) were enrolled, among which, 42 were classified into low risk group, while 49 were intermediate-high risk group. Compared with low-risk patients, those with intermediate-high risk had significantly larger 3DE-RV volumes, worse ejection fraction (EF) and tricuspid annular plane systolic excursion, and decreased longitudinal strain (LS). Receive operating characteristic curves illustrated all the 3DE parameters were able to predict intermediate-high risk stratification, especially 3D-RVEF (area under curve, 0.82, 95% CI 0.73–0.91, P < 0.001). And 3D-RVEF < 26.39% had a 81.6% sensibility and 73.8% specificity to predict intermediate-high risk stratification. Univariate and multivariate Logistic regression analyses identified 3D-RV end-diastolic (OR 1.02, 95% CI 1.01–1.03, P = 0.002) and end-systolic (OR 1.03, 95% CI 1.01–1.04, P < 0.001) volumes, 3D-RVEF (OR 0.82, 95% CI 0.75–0.90, P < 0.001) and LS of free wall (OR 1.17, 95% CI 1.05–1.31, P = 0.005) as independent predictors of intermediate-high risk stratification. In conclusion, RV volumes, EF and free wall strain detected by 3DE were independent predictors of intermediate-high risk stratification in PAH patients, among which, RVEF showed the best predictive capacity.

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Acknowledgements

The present study was supported by the grant of Capital Health Development and Scientific Research Projects (Grant No. 2016-2-4036), CAMS Initiative for Innovative Medical (Grant No. 2016-I2 M-3-006) and PUMC Innovation fund for graduate students (Grant No. 2018-1002-01-18).

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Authors and Affiliations

  1. Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People’s Republic of China

    Bing-Yang Liu, Qi-Xian Zeng, Zhi-Hong Liu, Qin Luo, Zhi-Hui Zhao, Rui-Lin Quan, Jian-Guo He & Chang-Ming Xiong

  2. Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China

    Wei-Chun Wu, Li-Li Niu, Yue Tian, Jing-Ru Lin & Hao Wang

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Liu, BY., Wu, WC., Zeng, QX. et al. The value of three-dimensional echocardiography in risk stratification in pulmonary arterial hypertension: a cross-sectional study. Int J Cardiovasc Imaging 36, 577–584 (2020). https://doi.org/10.1007/s10554-019-01743-1

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