Abstract 4353230: The prognostic accuracy of three-dimensional echocardiography in patients with pre-capillary pulmonary hypertension

Aims: To investigate the prognostic accuracy of three-dimensional echocardiographic (3DE) right ventricular (RV) data and compare it with that of risk stratification based on 2015 ESC Guidelines in pre-capillary pulmonary hypertension (PcPH) patients. Methods: We prospectively enrolled PcPH patients from March 2017 to May 2018. 3DE sequences were analyzed by semi-automatic software (TomTec 4D RV-Function 2.0). RV end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction, longitudinal strain of septum and free wall, tricuspid annular plane systolic excursion were obtained. All participants were classified into low and intermediate-high risk groups based on 2015 ESC Guidelines. Patients were followed-up till May 2019 for death due to RV failure as an end-point. Results: We finally enrolled 112 PcPH patients (average 36 years, 39 males and 73 females) in our study. Mean follow-up time was 18 months, and 11 patients died. Receive operating characteristic curves identified RV-3D-EDV=150ml and RV-3D-ESV=109ml as optimal cut-offs. Multivariate Cox proportional regression analyses indicated RV-3D-EDV＞150ml and RV-3D-ESV＞109ml were independent predictors of mortality after adjusted by age, gender, BMI or Risk stratification. McNemar-Bowker test revealed that compared with risk stratification, RV-3D-EDV＞150ml (67.3% vs 44.6%, P ＜0.01) and RV-3D-ESV＞109ml (62.4% vs 44.6%, P ＜0.01) had better predictive specificities for end-point. Conclusion: RV volumes detected by three-dimensional echocardiography had the potential to predict death due to RV failure in PcPH patients, and their prognostic accuracy were non-inferior to that of risk stratification recommended by 2015 ESC Guidelines.