PMID- 30572401 OWN - NLM STAT- MEDLINE DCOM- 20190208 LR - 20190215 IS - 0253-3758 (Print) IS - 0253-3758 (Linking) VI - 46 IP - 12 DP - 2018 Dec 24 TI - [Value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension]. PG - 965-971 LID - 10.3760/cma.j.issn.0253-3758.2018.12.007 [doi] AB - Objective: To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH). Methods: In this prospective study, 51 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. The patients were aged (45.8+/-15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4+/-14.6) years old in control 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 from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration. Results: There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . 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=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4+/-2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively. Conclusions: RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent. FAU - Zhang, X M AU - Zhang XM AD - Department of Cardiology, Renji Hospital (South), Shanghai Jiaotong University School ofMedicine, Shanghai 201112, China. FAU - Zhuang, Q AU - Zhuang Q FAU - Yang, M H AU - Yang MH FAU - Wang, W AU - Wang W FAU - Zheng, Y AU - Zheng Y FAU - Qiao, Z Q AU - Qiao ZQ FAU - Shen, J Y AU - Shen JY FAU - Shen, X D AU - Shen XD LA - chi GR - 2017PYM03/National Natural Science Found Cultivation Project of Renji Hospital (South) Affiliated to Shanghai Jiaotong University School of Medicine/ GR - 2016MW64/Shanghai Minhang District Health Planning Commission Project/ PT - Journal Article PL - China TA - Zhonghua Xin Xue Guan Bing Za Zhi JT - Zhonghua xin xue guan bing za zhi JID - 7910682 SB - IM MH - Adult MH - China MH - Echocardiography MH - *Echocardiography, Four-Dimensional MH - Female MH - Humans MH - *Hypertension, Pulmonary/diagnostic imaging MH - Male MH - Middle Aged MH - Prognosis MH - Prospective Studies MH - Stroke Volume MH - *Ventricular Dysfunction, Right MH - Ventricular Function, Right OTO - NOTNLM OT - Echocardiography, four-dimensional OT - Hypertension, pulmonary OT - Prognosis OT - Ventricular function, right EDAT- 2018/12/21 06:00 MHDA- 2019/02/09 06:00 CRDT- 2018/12/21 06:00 PHST- 2018/12/21 06:00 [entrez] PHST- 2018/12/21 06:00 [pubmed] PHST- 2019/02/09 06:00 [medline] AID - 10.3760/cma.j.issn.0253-3758.2018.12.007 [doi] PST - ppublish SO - Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Dec 24;46(12):965-971. doi: 10.3760/cma.j.issn.0253-3758.2018.12.007.