Advantages of Real Time Three-Dimensional Echocardiography in the Assessment of Right Ventricular Volumes and Function in Patients with Pulmonary Hypertension Compared with Conventional Two-Dimensional Echocardiography

Background: In recent years, right ventricular (RV) function has acquired greater relevance as a clinical and prognostic marker in many physiopathological conditions. The study aims to point out the value of real time three-dimensional echocardiography (RT3DE) and tissue Doppler imaging (TDI) in the evaluation of patients affected by pulmonary hypertension (PH), compared with conventional two-dimensional (2D) echocardiography. Methods: We enrolled 44 subjects affected by PH who underwent 2D and Doppler echocardiography, RT 3D Echocardiography and TDI evaluation of the RV, and a healthy control group. PH itself can induce severe functional and structural abnormalities of the RV, such as RV hypertrophy, RV dilation, and RV systolic and diastolic dysfunction. Results: In this study, RV FAC, and TAPSE showed marked alterations in patients with PH compared to the control group (C): (RVFAC: [PH] 0.29 +/- 0.07 vs. [C] 0.49 +/- 0.05%, P < 0.0001; TAPSE: [PH] 15.3 +/- 3.2 vs. [C] 21.1 +/- 2.6 mm, P > 0.0001). The 3D RV end-diastolic volume was significantly higher in PH than in C (PH) (138.7 +/- 25.3 vs. [C] 82.8 +/- 12.5 mL, P < 0.0001] as well as 3D RV end-systolic volume (PH) (97.6 +/- 21.5 vs. [C] 39.3 +/- 9.5 mL, P < 0.0001). The 3D RV ejection fraction (EF) was significantly lower in the pulmonary hypertension group than in healthy subjects (31.8 +/- 6.8 vs. [C] 52.5 +/- 4.7%, P < 0.0001). Conclusions: In patients with PH, evaluation of the RV diastolic and systolic volume and EF by RT3DE has shown a higher discriminating power in comparison, respectively, with 2DRV diastolic area and the relative fractional area changes. (Echocardiography 2013;30:820-828)