Clinical Value of Real‐Time Three‐Dimensional Echocardiography for Evaluating Right Ventricular Structure and Function in Patients With Pulmonary Hypertension Across Different Echocardiographic Pulmonary Artery Systolic Pressure Strata

OBJECTIVE: To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular (RV) structure and function in patients with pulmonary hypertension (PH) across different echocardiographic pulmonary artery systolic pressure (PASP) strata. METHODS: A total of 150 patients with PH and 84 healthy controls were included. Patients with PH were stratified into mild, moderate and severe echocardiographic PASP strata. Conventional two-dimensional (2D) echocardiographic parameters and RT-3DE-derived RV parameters were compared among groups. Correlations between echocardiographic parameters and pulmonary pressure burden were analyzed. Cross-validated receiver operating characteristic analyses were performed to evaluate the diagnostic performance of 2D parameters, RT-3DE parameters and combined 2D plus RT-3DE models. RESULTS: PH etiologies included Group 1 pulmonary arterial hypertension (31.3%), Group 2 PH due to left heart disease (51.3%), Group 3 PH due to lung disease and/or hypoxia (11.3%), Group 4 PH associated with pulmonary artery obstruction (1.4%), and Group 5 PH with unclear and/or multifactorial mechanisms (4.7%). RV-TD, RV/LV ratio, RAEA, and RV-FW increased across echocardiographic PASP strata, whereas S', TAPSE, RVFAC, and RVEF decreased. RT-3DE-derived RV volume and functional parameters differed significantly among groups; within the PH cohort, RVEDV, RVESV, RVSV, and RV cardiac output increased across PASP strata, while RVEF progressively decreased. The combined 2D plus RT-3DE model showed high cross-validated discrimination for moderate-to-severe PH and severe PH, with AUCs of 0.956 and 0.998, respectively. CONCLUSION: Combined 2D echocardiography and RT-3DE provide complementary noninvasive information for evaluating RV remodeling and systolic dysfunction in patients with PH across different echocardiographic PASP strata.