TL;DR
The RV: LV EDV ratio correlated better with PR fraction than did RV EDVi, and accordingly, it may better reflect the response of the RV to PR.
Background: Pulmonary hypertension (PH) is associated with increased pulmonary arterial pressure and impairment of right ventricular (RV) function. Reliable characterization of RV performance is important for prognosis, risk assessment, and therapeutic planning. Cardiac magnetic resonance (CMR) is considered the reference technique for quantifying RV volumes and function, but its expense and limited availability can restrict routine implementation. Echocardiography is more widely accessible; however, the extent to which individual echocardiographic indices correspond with CMR-derived RV ejection fraction (RVEF) remains incompletely defined. Objective: Our objective was to determine the correlation of RV fractional area change (RV-FAC), RV free-wall longitudinal strain (RV-FWLS), and RV global longitudinal strain (RV-GLS) with CMR-derived RVEF in individuals with PH. Methods: PubMed, Embase, ClinicalTrials.gov, Scopus, and the Cochrane Library were searched, yielding 404 records; six studies fulfilled the eligibility criteria. Studies were eligible when they enrolled patients with PH and provided extractable correlations between at least one prespecified echocardiographic measure and CMR-derived RVEF. Correlation coefficients were converted with Fisher’s z transformation, combined using common-effect and random-effects approaches, and then transformed back to correlation coefficients. Pooled mean RV-FAC was evaluated as a separate outcome. Between-study heterogeneity was quantified with I2 and τ2, with random-effects estimates emphasized for interpretation. Results: Each evaluated echocardiographic measure was positively correlated with CMR-derived RVEF. RV-FWLS had the largest pooled correlation and the greatest consistency (r = 0.79, 95% CI: 0.73–0.83; I2 = 0.0%). The pooled correlation for RV-GLS was 0.75 (95% CI: 0.60–0.85; I2 = 80.3%), while that for RV-FAC was 0.72 (95% CI: 0.61–0.80; I2 = 61.8%). The random-effects pooled mean RV-FAC was 31.10% (95% CI: 26.77–35.43), with substantial heterogeneity (I2 = 90.9%). Conclusions: RV-FWLS showed the highest numerical and most consistent association with CMR-derived RVEF, suggesting that it may serve as a useful non-invasive adjunct for RV assessment in PH, especially where CMR is not readily available. Larger studies using harmonized acquisition and analysis methods are required for confirmation.
RA phasic strain is impaired in ARVC even when RV function is preserved and in combination with RVGLS, RA conduit strain showed improved diagnostic performance and may serve as a potential adjunctive imaging marker, although further evaluation is required.
BACKGROUND Right ventricular (RV) to left ventricular (LV) end-diastolic volume ratio (RV/LV) is a validated marker of RV dilation in pulmonary arterial hypertension (PAH), yet its impact on LV myocardial function and the underlying mediating pathway is incompletely characterized. PURPOSE To investigate the association between RV/LV volume ratio and LV dysfunction in PAH patients, with a focus on regional strain patterns and mediating pathways. STUDY TYPE Retrospective. POPULATION 188 PAH patients were divided into normal (ratio < 1.27, n = 74) and elevated (ratio ≥ 1.27, n = 114) RV/LV volume ratio groups, and 81 age- and sex-matched controls. FIELD STRENGTH/SEQUENCE 3.0-T/balanced steady-state free precession cine sequence. ASSESSMENT LV global longitudinal, circumferential, and radial strains (LVGLS, LVGCS, and LVGRS, respectively) and regional strains were measured using feature tracking. Strain parameters were compared among controls and PAH subgroups. STATISTICAL TESTS One-way ANOVA with Bonferroni-corrected post hoc tests, Kruskal-Wallis test, and Pearson or Spearman correlation. Multivariable linear regression was used to identify independent determinants and mediation analysis to examine the mediating pathways. A two-tailed p < 0.05 was deemed statistically significant. RESULTS PAH patients with elevated volume ratio had significantly reduced LVGCS and LVGLS. Regional analysis showed that the most extensive strain impairment was at the mid-ventricular septum. The RV/LV volume ratio was independently associated with LVGCS (β = -0.194) and LVGLS (β = -0.307). Mediation analysis demonstrated that the mPAP-LVGLS relationship was statistically mediated by the RV/LV volume ratio, with a significant indirect effect (β = -0.192, 95% confidence interval: -0.302 to -0.096) and a non-significant (p = 0.544) direct effect. DATA CONCLUSION Elevated RV/LV volume ratio in PAH is associated with spatially heterogeneous LV strain impairment, with the mid-septum being most vulnerable. The ratio mediates the adverse impact of pulmonary pressure on LV longitudinal strain and may serve as an imaging marker for assessing LV dysfunction. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 3.
BACKGROUND In advanced heart failure with preserved ejection fraction (HFpEF), right ventricular (RV) dysfunction and impaired RV-pulmonary artery (PA) coupling are increasingly recognized as contributors to prognosis. While conventional echocardiography mainly assesses longitudinal RV function, three-dimensional (3D) imaging enables more comprehensive evaluation. We investigated the prognostic value of 3D-derived RV function and RV-PA coupling in patients with HFpEF. METHODS Of 311 prospectively enrolled patients with HFpEF between 2022 and 2023, 229 (age 74.1 ± 10.3 years; 41.5% male) were analyzed. 3D RV ejection fraction (RVEF), pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), RV free-wall longitudinal strain (RVFWS), and coupling indices (3D RVEF/PASP, TAPSE/PASP, and RVFWS/PASP) were assessed. The primary endpoint was a composite of cardiovascular death or heart failure hospitalization. RESULTS During a median follow-up of 23.5 months, 34 patients (14.8%) experienced the primary endpoint. Reduced 3D RVEF and impaired 3D RVEF/PASP were associated with higher event rates. On time-dependent ROC analysis, 3D RVEF/PASP showed higher discriminatory ability than TAPSE/PASP at 6, 12, and 18 months (P = .009, .032, and .021, respectively). In multivariable Cox analysis, 3D RVEF/PASP remained independently associated with adverse outcomes (adjusted HR 0.86, 95% CI 0.77-0.96; P = .007). The prognostic value of 3D RVEF/PASP persisted in patients with moderate-to-severe TR. CONCLUSIONS 3D RVEF/PASP independently predicted cardiovascular outcomes and showed higher prognostic discrimination than TAPSE/PASP in HFpEF. 3D RV-PA coupling may provide complementary information for noninvasive risk stratification.
Three-dimensional echocardiography compared well with CMR in delineation of severity of regurgitation (mild, moderate, and severe) and intra- and intra-observer reliability was excellent for ventricular volumes, VVR, and RF.
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