ArticleEuropean heart journal. Imaging methods and practice2026
Advanced right ventricular evaluation in pulmonary hypertension: the role of 3D echocardiography and strain analysis.
Article in European heart journal. Imaging methods and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Right ventricular (RV) dysfunction is a key prognostic factor in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Evaluation by cardiac magnetic resonance imaging (cMRI) is preferred, but it is expensive and time-consuming. We therefore tested whether semiautomated, three-dimensional transthoracic echocardiography and RV free-wall strain could discriminate between clinical risk groups. Methods and results: We studied 49 patients with PAH or CTEPH. Study participants underwent cMRI and 2D and 3D echocardiography with the assessment of measures of RV size and function. Patients were categorized into low and non-low clinical risk groups based on a modified version of the ESC/ERS four-strata risk-assessment model. Among the non-low-risk patients, cMRI found an elevated RV end-diastolic and end-systolic volume, and a reduced RV ejection fraction, after adjustment for disease subtype, age, sex, BMI, and smoking status, compared to the low-risk group; 3D echocardiography confirmed a higher end-diastolic and end-systolic volume in the non-low-risk group (191 ± 61 mL vs. 151 ± 44 mL, Conclusion: Larger 3D-echocardiographic RV volumes and reduced free-wall strain were associated with a worse clinical risk profile in PAH and CTEPH, whereas RV ejection fraction and traditional 2D measures were not. These parameters offer a practical alternative to cMRI for evaluating RV remodeling.
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