Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension
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Mitsushige Murata1, Toshimitsu Tsugu2, Takashi Kawakami2, Masaharu Kataoka2, Yugo Minakata2, Jin Endo2, Hikaru Tsuruta2, Yuji Itabashi2, Yuichiro Maekawa2, Mitsuru Murata1, Keiichi Fukuda2
1Department of Laboratory Medicine, Keio University, Tokyo, Japan
2Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
Mitsushige Murata, email: [email protected]
Keywords: right ventricular function, right ventricular ejection fraction, pulmonary arterial hypertension, three-dimensional echocardiography, prognosis
Received: September 20, 2016 Accepted: November 08, 2016 Published: November 22, 2016
Background: Right ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH.
Results: Most of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan-Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.
Materials and Methods: Eighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF.
Conclusions: RVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.
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