Outcomes in pulmonary hypertension (PH) are related to right ventricular (RV) function and remodeling. We hypothesized that changes in RV function, especially area strain (AS), could provide incremental prognostic data as compared to baseline data. We aimed to assess RV function changes between baseline and 6-months visit and evaluate their prognostic value in PH using 3D echocardiography.

95 PH patients were prospectively included in this longitudinal study. All patients underwent 2D and 3D transthoracic echocardiography at baseline and 6-month follow-up. 3D RV echocardiographic sequences were analyzed by semi-automatic software and output meshes were post-processed to extract regional deformation.

Improvements in the global area strain (lower 2nd measure of area strain) were associated with stable or improving clinical condition as well as survival free from transplant (P<0.001). The most significant regional changes occurred within the septum. Over a median follow-up of 24.8 months [22.1–25.7], 21 patients died from PH or were transplanted. On multivariate COX analysis, changes in WHO class, BNP and RV global AS were independent predictors of outcomes. Using follow-up data, RV area strain significantly improves the current risk stratification.

Changes in RV function and especially follow-up 3D RV AS and RV end-diastolic volume are of prognostic importance. Our study underlines the importance of follow-up data in comparison with baseline data only and demonstrates the additional prognostic value of following changes in RV deformation using 3D echocardiography (Figure 1, Death or transplant).