The Prognostic Accuracy of Three-Dimensional Echocardiography in Patients With Pre-Capillary Pulmonary Hypertension

To investigate the prognostic accuracy of three-dimensional echocardiographic (3DE) right ventricular (RV) data and compare it with that of risk stratification based on 2015 ESC Guidelines in pre-capillary pulmonary hypertension (PcPH) patients. We prospectively enrolled PcPH patients from March 2017 to May 2018. 3DE sequences were analyzed by semi-automatic software (TomTec 4D RV-Function 2.0). RV end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction, longitudinal strain of septum and free wall, tricuspid annular plane systolic excursion were obtained. All participants were classified into low and intermediate-high risk groups based on 2015 ESC Guidelines. Patients were followed-up till May 2019 for death due to RV failure as an end-point. We finally enrolled 112 PcPH patients (average 36 years, 39 males and 73 females) in our study. Mean follow-up time was 18 months, and 11 patients died. Receive operating characteristic curves identified RV-3D-EDV = 150 mL and RV-3D-ESV = 109 mL as optimal cut-offs. Multivariate Cox proportional regression analyses indicated RV-3D-EDV > 150 mL and RV-3D-ESV > 109 mL were independent predictors of mortality after adjusted by Risk stratification. McNemar-Bowker test revealed that compared with risk stratification, RV-3D-EDV > 150 mL (67.3% vs. 44.6%, p < 0.01) and RV-3D-ESV > 109 mL (62.4% vs. 44.6%, p < 0.01) had better predictive specificities for end-point. RV volumes detected by three-dimensional echocardiography suggested potential prognostic value for risk stratification in PH patients, warranting validation in larger cohorts.