title: Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Laboratory Medicine, Keio University, Tokyo, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Murata
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Tsugu
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawakami
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Kataoka
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Minakata
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Endo
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Tsuruta
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itabashi
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Laboratory Medicine, Keio University, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Murata
authors.affiliation: Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000503:physiopathology*
keywords: prognosis; pulmonary arterial hypertension; right ventricular ejection fraction; right ventricular function; three-dimensional echocardiography