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Updated: Aug 26, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Right Ventricular-Pulmonary Artery Coupling by 3D Echocardiography Predicts Outcomes in Heart Failure with Preserved
Heekyung Seo1, Kyu Kim1, Seonhwa Lee1
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Background:
In advanced heart failure with preserved ejection fraction (HFpEF), right ventricular (RV) dysfunction and impaired RV-pulmonary artery (PA) coupling are increasingly recognized as contributors to prognosis. While conventional echocardiography mainly assesses longitudinal RV function, three-dimensional (3D) imaging enables more comprehensive evaluation. We investigated the prognostic value of 3D-derived RV function and RV-PA coupling in patients with HFpEF.
Methods:
Of 311 prospectively enrolled patients with HFpEF between 2022 and 2023, 229 (age 74.1 ± 10.3 years; 41.5% male) were analyzed. 3D RV ejection fraction (RVEF), pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), RV free-wall longitudinal strain (RVFWS), and coupling indices (3D RVEF/PASP, TAPSE/PASP, and RVFWS/PASP) were assessed. The primary endpoint was a composite of cardiovascular death or heart failure hospitalization.
Results:
During a median follow-up of 23.5 months, 34 patients (14.8%) experienced the primary endpoint. Reduced 3D RVEF and impaired 3D RVEF/PASP were associated with higher event rates. On time-dependent ROC analysis, 3D RVEF/PASP showed higher discriminatory ability than TAPSE/PASP at 6, 12, and 18 months (P = .009, .032, and .021, respectively). In multivariable Cox analysis, 3D RVEF/PASP remained independently associated with adverse outcomes (adjusted HR 0.86, 95% CI 0.77-0.96; P = .007). The prognostic value of 3D RVEF/PASP persisted in patients with moderate-to-severe TR.
Conclusions:
3D RVEF/PASP independently predicted cardiovascular outcomes and showed higher prognostic discrimination than TAPSE/PASP in HFpEF. 3D RV-PA coupling may provide complementary information for noninvasive risk stratification.
