Incremental prognostic value of advanced echocardiographic over standard 2D assessment in a real-world clinical population
F Heilbron, V Volpato, M Penso, G Benzoni, M Tomaselli, F Ciambellotti, D Muraru, L P BadanoAbstract
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.Incremental value advanced vr standard echo