Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Mitsushige Murata, Toshimitsu Tsugu, Takashi Kawakami, Masaharu Kataoka, Yugo Minakata, Jin Endo, Hikaru Tsuruta, Yuji Itabashi, Yuichiro Maekawa, Mitsuru Murata, Keiichi Fukuda

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Background: Right ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH. Results: Most of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan- Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH. Materials and Methods: Eighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF. Conclusions: RVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.

Original languageEnglish
Pages (from-to)86781-86790
Number of pages10
Issue number52
Publication statusPublished - 2016


  • Prognosis
  • Pulmonary arterial hypertension
  • Right ventricular ejection fraction
  • Right ventricular function
  • Three-dimensional echocardiography

ASJC Scopus subject areas

  • Oncology


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