Three‐Dimensional Echocardiography and 2D‐3D Speckle‐Tracking Imaging in Chronic Pulmonary Hypertension: Diagnostic Accuracy in Detecting Hemodynamic Signs of Right Ventricular (RV) Failure

Abstract

BackgroundOur aim was to compare three‐dimensional (3D) and 2D and 3D speckle‐tracking (2D‐STE, 3D‐STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure.Methods and ResultsSeventy‐three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV–fractional area change–tricuspid annular plane systolic excursion) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes and global and regional ejection fraction (3D‐RVEF) were determined. RV strains were calculated by 2D‐STE and 3D‐STE. RV 3D global‐free‐wall longitudinal strain (3DGFW‐RVLS), 2D global‐free‐wall longitudinal strain (GFW‐RVLS), apical‐free‐wall longitudinal strain, basal‐free‐wall longitudinal strain, and 3D‐RVEF were lower in patients with precapillary PH (P<0.0001) and postcapillary PH (P<0.01) compared to controls. 3DGFW‐RVLS (hazard ratio 4.6, 95% CI 2.79 to 8.38, P=0.004) and 3D‐RVEF (hazard ratio 5.3, 95% CI 2.85 to 9.89, P=0.002) were independent predictors of mortality. Receiver operating characteristic curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D‐RVEF (AUC 0.89), −17% for 3DGFW‐RVLS (AUC 0.88), −18% for GFW‐RVLS (AUC 0.88), −16% for apical‐free‐wall longitudinal strain (AUC 0.85), 16 mm for tricuspid annular plane systolic excursion (AUC 0.67), and 38% for RV‐FAC (AUC 0.62).ConclusionsIn chronic PH, 3D, 2D‐STE and 3D‐STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices.

Echocardiographic Test and the Early Detection of Systolic Failure in Systemic Sclerosis Patients: Strain and Strain Rate Echocardiography

“…The possibility of RV failure diagnosis in 3D echocardiography and 2D-3D speckle-tracking imaging has been reported by Vitarelli et al (17). In addition, Stergiopoulos et al have shown that speckle-tracking echocardiography (STE) is a sensitive tool for RV dysfunction assessment in acute pulmonary embolism patients (18).…”

Prevalence, Predictors, and Prognostic Value of Residual Tricuspid Regurgitation in Patients With Left Ventricular Assist Device

“…Significant improvement of RVFAC after LVAD implantation may attenuate the association between RVFAC and residual TR. Furthermore, RVFAC emerged as a poor parameter for the determination of RV contractility in recent studies,29, 30 suggesting that, in the presence of TR, estimates of radial contraction may misdiagnose the presence of RV dysfunction because of the decrease in RV afterload caused by the leaking valve, just as the LVEF assessment is limited by MR 13. Tricuspid annular plane systolic excursion, RV index of myocardial performance and/or assessment using 3‐dimensional echocardiography may provide additional information of RV contractility and its association with residual TR 30, 31.…”

“…Moreover, RV size and geometry are technically difficult to determine accurately with 2‐dimensional echocardiography because of its anatomic complexity. Although the 3‐dimensional echocardiography now offers an accurate and real‐time assessment of the size and shape of RV and the TV deformation,30, 36 high feasibility, and reproducibility of TV annulus diameter using 2‐dimensional echocardiography in apical 4‐chamber view has been reported when compared with 3‐dimensional echocardiography 26…”

Right Ventricle in Pulmonary Hypertension

“…Indeed, although standard 2D transthoracic echocardiography has provided merely 3 potential treatment goals-preserved tricuspid annulus systolic excursion, normal right atrial area, and the absence of pericardial effusion-modern right heart echocardiography has potentially more to offer. [10][11][12][13][14][15][16][17][18][19][20] Of note, in their study, Ryo et al did not follow this direction but limited the assessment to rather rudimental estimation of RV volumes, simply expecting better precision of the measurements assisted by 3D wall motion tracking when compared with traditional 2D echocardiography. Similar to CMR, this still required manual tracing of endocardial and epicardial borders.…”