Value Of Four-dimensional Echocardiography Combined With Speckle Tracking On The Assessment Of Right Heart Function And Prognosis In Patients With Pulmonary Arterial Hypertension

Objective: To investigate the value of four-dimensional echocardiography combined with speckle tracking on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension(PAH).Methods: In this prospective study,54 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017.Meanwhile,26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group.were recruited as control group.The patients were aged(44.58±15.45)years old in PAH group,and there were 7 males and 47 females.The patients were aged(45.1±14.6)years old in PAH group,and there were 4 males and 22 females.Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart.The myocardial strain of each ventricle and atrium was measured by sparkle tracking.The patients in PAH group were followed up to January 2019 to observe the endpoint events including all-cause death and rehospitalization。Results: There were significant differences in two-dimensional echocardiographic parameters,speckle tracking parameters and fourdimensional echocardiographic parameters between control group and PAH group(all P<0.01 or 0.05)except RASr.Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579,P<0.001),RVSP(r=-0.442,P=0.002),RVGLS(r=-0.521,P<0.001),LASr(r=0.462,P=0.001),RASr(r=0.379,P<0.001)and RVFLS(r=-0.476,P=0.001).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance(r=0.540,P<0.001),B-type natriuretic peptide(r=-0.554,P<0.001),New York Heart Association(NYHA)cardiac function classification(r=-0.614,P<0.001),TAPSE(r=0.595,P<0.001),LVGLS(r=-0.461,P=0.001),LASc(r=0.454,P=0.002),RASc(r=0.435,P=0.003).After a follow-up of(250.4±98.3)days,there were 4 all-cause deaths and 4 re-hospitalizations.Multivariate Cox regression analysis showed that elevated 6MWD and RVEF were independent protective factors for end-point events in PAH patients.The ROC curve showed that BNP,6MWD and RVEF had high predictive value for the occurrence of end-point events in patients with pulmonary hypertension.The area under the curve(AUC)was 0.8201,0.8569 and 0.777 respectively(all P less than 0.05).Meanwhile,there were significant correlations between right atrial function and clinical or ultrasonographic indicators of right ventricular function,except the correlations between RASp and RVSP or RVEF.The results of ROC analysis also showed that RASr(AUC = 0.75,P = 0.0251)and RASp(AUC = 0.7595,P = 0.0201)were useful in evaluating the prognosis of patients.Conclusion: RVEF measured by four-dimensional echocardiography is correlated with clinical parameters,two-dimensional echocardiography and speckle tracking parameters,and can predict the prognosis of patients with pulmonary hypertension,and 6MWD have the strongest prognostic effect.Right atrial functions are related to cardiac function.RASr and RASp also play a role in predicting the prognosis of patients.