Clinical Value of Real‐Time Three‐Dimensional Echocardiography for Evaluating Right Ventricular Structure and Function in Patients With Pulmonary Hypertension Across Different Echocardiographic Pulmonary Artery Systolic Pressure Strata
Junlan Liu, Yihua WangABSTRACT
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.