Evaluation Of Right Ventricular Function In Patients With Pulmonary Hypertension Duo To Left Heart Disease Using Two-Dimensional Speckle Tracking And Real Time Three-Dimensional Echocardiography

Objective:To assess right ventricular function in patients with pulmonary hypertension due to left heart disease (LHD-PH) and explore the ability to differentiate passive PH and reactive PH using two-dimensional speckle tracking echocardiography (2D-STE) and real time three-dimensional echocardiography (RT-3DE).Methods:The study consisted of 40 controls and 65 patients with LHD-PH. Patients were divided into passive PH and reactive PH groups according to pulmonary vascular resistance (PVR). Fractional area change (FAC) was acquired by conventional echocardiography and systolic velocity (S’) of tricuspid annulus was measured by tissue Doppler imaging. Longitudinal peak systolic strain (LS) was measured at the basal (LSbas), middle (LSmid) and apical segments (LSapi) of right ventricular free wall (FW) by 2D-STE, and global LS (LSfw) was calculated. Right ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and stroke volume (SV) were acquired using RT-3DE.Results:Compared with controls, EDV and ESV increased in LHD-PH patients (all P< 0.05), and LSbas, LSfw and EF decreased in reactive PH group (all P< 0.05). Compared with passive PH group, EDV and ESV increased in reactive PH group, while LSbas, LSfw and EF decreased (all P< 0.05). When cut-off values of LSbas, EDV and EF were-21.86%,75.65ml and 37.25%, they were of great value in identifying reactive PH with sensitivity of 83%,59% and 72%, and specificity of 89%, 72% and 75%, respectively. However, FAC and S’foiled to identify reactive PH with undesirable areas under the ROC curves (0.281 vs.0.227).Conclusions:Right ventricular function can be evaluated by 2D-STE and RT-3DE. Right ventricular presented gradual dilatation with deteriorated systolic function that occurred late. Two-dimensional strain combined with three-dimensional volumetric assessment were able to discriminate reactive PH from passive PH better than conventional echocardiography, and in turn leads to timely evaluation of disease severity as well as appropriate treatment.