Incremental prognostic value of changes in 3D right ventricular function in pulmonary hypertension

BackgroundOutcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function andremodeling. We hypothesized that changes in RV function, especially area strain (AS), couldprovide incremental prognostic data.PurposeTo assess global and regional 3D RV function changes between baseline and 6-months visit andevaluate their prognostic value in PH.MethodsIn total, 65 PH patients were prospectively included in this longitudinal study. All patientsunderwent 2D and 3D transthoracic echocardiography at baseline and 6-month follow-up. 3D RVechocardiographic sequences were analyzed by semi-automatic software and output meshes werepost-processed to extract regional deformation.ResultsAt baseline, there was no significant difference in RV AS between patient subgroups. Patients whowere considered clinically stable or improving presented at 6-months a significant increase in RVEF (P = 0.04) and decrease in RV global AS (P = 0.001) (Fig. 1). The most significant regionalchanges occurred within the septum. Over a median follow-up of 24.8 months [22.1–25.7], 16patients died from PH or were transplanted. On multivariate COX analysis, 6-month changes inWHO class (HR 17.4[5.2–58.5]), BNP (HR 1.003[1.001–1.004]) and RV global AS (HR 1.12[1.03–1.21]) were independent predictors of survival.ConclusionChanges in WHO function class, BNP and 3D RV AS could help stratifying the PH patients' risk.Our study demonstrates the additional prognostic value of following changes in RV deformationusing 3D echocardiography.