Abstract 18080: Three-Dimensional Echocardiographic Wall Motion Tracking Assessment of Right Ventricular and Right Atrial Remodeling as Prognostic Predictors in Patients With Pulmonary Hypertension

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Background: Chronic pulmonary hypertension (PH) is associated with variable degrees of right ventricular (RV) remodeling and right atrial (RA) remodeling.

Hypothesis: We hypothesized that three-dimensional (3D) echocardiographic assessments of RV remodeling and RA remodeling are of additive prognostic value in patients with PH.

Methods: We studied 63 patients with pre-capillary PH using 3D echocardiography (Artida, Toshiba Corp.) and wall motion tracking. We calculated 3D RV volume and RA volume. Volume information was indexed body surface area. Twenty-two subjects were included as normal controls. We followed patients’ predefined outcome events for 6 months including death or lung transplantation.

Results: 3D RV volume and RA volume were feasible in 59 of the 63 patients (94%). RV end-systolic volume index (RVESVI) and RA volume index (RAVI) in PH patients were greater than normal subjects (76.0±32.1 ml/m2 vs. 38.9±7.0 ml/m2, 53.8±38.1 ml/m2 vs. 28.8±7.3 ml/m2, p < 0.001, respectively). Baseline RVESVI of 70 ml/m2 and baseline RAVI 56ml/m2 were associate with patients’ outcome [Sensitivity (Sn) 94%, Specificity (Sp) 67%, Area Under Curve (AUC) 0.87, p = 0.001, Sn 84%, Sp 81%, AUC 0.83, p = 0.001], respectively. RVESVI≥70 ml/m2 and RAVI≥56 ml/m2 showed significantly worse prognosis [hazard ratio (HR) of 10.72, 95% confidence interval (95% CI) of 2.98 to 68.42, p < 0.001; HR 9.49, 95% CI of 3.27 to 34.18, p < 0.001, respectively]. The patients with combined RVESVI≥70 ml/m2 and RAVI≥56 ml/m2 had the most unfavorable outcomes (Log-rank, p = 0.001).

Conclusion: RV remodeling and RA remodeling were strongly associated with the unfavorable outcomes in patients with PH. Three-dimensional assessment of both RV and RA morphology and function may be a useful new approach to predict outcome in patients with PH.

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