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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 3-Dimensional Echocardiography Predicts Outcomes in Heart Failure with
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, 3-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. Three-dimensional RV ejection fraction (RVEF), PA 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 end point 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 end point. Reduced 3D RVEF and impaired 3D RVEF/PASP were associated with higher event rates. On time-dependent receiver operating characteristic 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 hazard ratio = 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:
Three-dimensional RVEF/PASP independently predicted cardiovascular outcomes and showed higher prognostic discrimination than TAPSE/PASP in HFpEF. Three-dimensional RV-PA coupling may provide complementary information for noninvasive risk stratification.
