Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

Abstract

Background: Right ventricular (RV) function plays a vital role in the prognosis of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We used new machine learning (ML)-based fully automated software to quantify RV function using three-dimensional echocardiography (3DE) to predict adverse clinical outcomes in CTEPH patients.Methods: A total of 151 consecutive CTEPH patients were registered in this prospective study between April 2015 and July 2019. New ML-based methods were used for data management, and quantitative analysis of RV volume and ejection fraction (RVEF) was performed offline. RV structural and functional parameters were recorded using 3DE. CTEPH was diagnosed using right heart catheterization, and 62 patients underwent cardiac magnetic resonance to assess right heart function. Adverse clinical outcomes were defined as PH-related hospitalization with hemoptysis or increased RV failure, including conditions requiring balloon pulmonary angioplasty or pulmonary endarterectomy, as well as death.Results: The median follow-up time was 19.7 months (interquartile range, 0.5–54 months). Among the 151 CTEPH patients, 72 experienced adverse clinical outcomes. Multivariate Cox proportional-hazard analysis showed that ML-based 3DE analysis of RVEF was a predictor of adverse clinical outcomes (hazard ratio, 1.576; 95% confidence interval (CI), 1.046~2.372; P = 0.030).Conclusions: The new ML-based 3DE algorithm is a promising technique for rapid 3D quantification of RV function in CTEPH patients.

Superior prognostic value of three-dimensional echocardiography-derived right ventricular ejection fraction: a meta-analysis

“…According to the predefined inclusion and exclusion criteria, 13 studies were found suitable. In three instances (including 3-3 studies), there was an apparent overlap between the patient cohorts (8, 12-16); therefore, studies with a higher number of participants were included (12, 14, 16). Overall, ten (12, 14, 16-23) independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE [n=8] (12, 15, 17, 19-23), or FAC [n=7] (12, 18-23), or FWLS [n=7] (16, 18-23), on clinical outcomes (all-cause mortality and/or cardiopulmonary adverse events) as HRs.…”

“…Others reported these effect sizes per standard deviation (SD) change. 9 To facilitate comparison of RVEF with TAPSE, FAC, and FWLS, all HRs and 95% CIs were rescaled by the within-study SD of the respective echocardiographic parameter to present a standardized change in the absolute value of each parameter (RVEF and TAPSE, or FAC, or FWLS) as previously described. 10 Each SD reduction in the given echocardiographic parameter represents an increase in hazard, resulting in direct comparability of the predictive value of these parameters.…”

“…The majority of studies reported HRs and 95% CIs relative to 1 unit increase in 3D RVEF (1% increase), TAPSE (1mm increase), FAC (1% increase), and FWLS (1% increase in absolute value). Others reported these effect sizes per standard deviation (SD) change (8). To facilitate comparison of RVEF with TAPSE, FAC, and FWLS, all HRs and 95% CIs were rescaled by the within-study SD of the respective echocardiographic parameter to present a standardized change in the absolute value of each parameter (RVEF and TAPSE, or FAC, or FWLS) as previously described (9).…”

“…According to the predefined inclusion and exclusion criteria, 13 studies were found suitable. In three instances (including 3-3 studies), there was an apparent overlap between the patient cohorts (8,(12)(13)(14)(15)(16); therefore, studies with a higher number of participants were included (12,14,16). Overall, ten (12,14,(16)(17)(18)(19)(20)(21)(22)(23) independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE [n=8] (12,15,17,(19)(20)(21)(22)(23), or FAC…”

Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography

“…Right ventricular (RV) dysfunction is associated with the worse outcome of several cardiac diseases including heart failure, cardiomyopathies, right ventricular myocardial infarction, congenital heart diseases, pulmonary arterial hypertension, and valvular heart diseases [1][2][3][4][5][6][7][8][9][10]. The assessment of right ventricular function by two-dimensional (2D) echocardiography remains challenging because of its complex anatomy, shape, and significant load dependence [1].…”