Abstract 13632: Multimodality Comparison of Echocardiographic Right Ventricular Function Parameters in Patients with Pulmonary Arterial Hypertension

Abstract

Background: Recently published American Society of Echocardiography (ASE) guidelines suggest a variety of two-dimensional echocardiography (2DE) parameters to assess right ventricular (RV) function but a direct comparison of the accuracy of these parameters in patients with pulmonary arterial hypertension (PAH) has not been performed. RV function using three-dimensional echocardiography (3DE) may be helpful but its performance is not well validated in patients with dysfunctional right ventricles.

Objectives: We aimed to prospectively compare the performance of the currently recommended 2DE and 3DE RV function parameters with cardiovascular magnetic resonance (CMR) in PAH patients.

Methods: 2DE, 3DE, and CMR imaging were performed on the same day in 25 PAH patients. RV function included speckle-tracking global longitudinal strain, tricuspid annular plane systolic excursion (TAPSE), Tei index, fractional area change (FAC), and systolic excursion velocity (S') by 2DE and RV ejection fraction (RVEF) by 3DE. All parameters were compared to CMR-derived RVEF.

Results: RV end-diastolic volume index by CMR was severely increased (132 ± 41 ml) with reduced RVEF (35 ± 14%). Of the 2DE parameters, global longitudinal strain and FAC correlated best with CMR-derived RVEF. 3DE-derived RVEF had the highest correlation with CMR (Figure) but slightly underestimated RVEF compared to CMR (bias -2%, 95% limits of agreement ± 18%).

Conclusion: Echocardiographic RV function is best measured in PAH patients using 3DE. In the absence of 3DE availability, 2DE-derived global longitudinal strain and FAC are also viable options. If confirmed in a larger group of patients with PAH, these results would warrant reassessment of the guidelines for the use of 3DE-derived RVEF in patients with significant RV dilation and dysfunction.