AimsNovel echocardiographic parameters of right ventricular (RV) function, including speckle‐tracking‐derived, three‐dimensional, and RV–pulmonary artery coupling parameters, have emerged for the evaluation of pulmonary arterial hypertension (PAH). The relative role of these parameters in the risk stratification of PAH patients is unclear. We compared the performance of multiple RV parameters and sought to establish an optimal model for identifying the risk profile of patients with PAH.Methods and resultsComprehensive risk assessments were performed for 70 patients with PAH. The risk profile of every patient was determined based on the guideline recommendations. Conventional parameters, including fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), novel speckle‐tracking‐derived RV longitudinal strain (RVLS), and three‐dimensional RV ejection fraction (3D‐RVEF), were used to evaluate RV function. Pressure–strain loops were measured for the assessment of RV myocardial work, including RV global wasted work (RVGWW). RV–pulmonary artery coupling was assessed by indexing RV parameters to the estimated pulmonary artery systolic pressure (PASP). The median age was 34 (30–43) years, and 62 (88.6%) patients were female. Forty‐five patients were classified into the low‐risk group, while 25 patients were classified into the intermediate–high‐risk group. Most RV parameters could be used to determine the risk profile and exhibited significantly improved diagnostic performance after indexing to PASP (including FAC/PASP, TAPSE/PASP, and 3D‐RVEF/PASP). RVLS/PASP showed the best performance, with an area under the curve of 0.895. In multivariate analysis (Model 1), only RVGWW (>90.5 mmHg%), RVLS (> −16.7%), and TAPSE (<17.5 mm) remained significant (all P < 0.05). Model 1 outperformed every single RV parameter, with a significantly larger area under the curve (all P < 0.05). With PASP indexing in Model 2, RVLS/PASP > −0.275 [odds ratio (OR) 20.63, 95% confidence interval (CI) 4.62–92.11, P < 0.001] and RVGWW > 90.5 mmHg% (OR 6.17, 95% CI 1.37–27.76, P = 0.018) independently identified a higher risk profile. The addition of RVGWW to two models determined incremental value in identification (continuous net reclassification improvement 1.058, 95% CI 0.639–1.477, P < 0.001).ConclusionsThe combination models for RV function outperformed any single parameter in identifying the risk profile of patients with PAH. Comprehensive assessment of RV–pulmonary artery coupling using multiparametric methods is clinically meaningful in patients with PAH.

中文翻译：

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肺动脉高压超声心动图右心室功能参数的最佳组合

目的右心室 (RV) 功能的新型超声心动图参数，包括斑点追踪衍生参数、三维参数和 RV-肺动脉耦合参数，已用于评估肺动脉高压 (PAH)。这些参数在 PAH 患者风险分层中的相对作用尚不清楚。我们比较了多个 RV 参数的表现，并试图建立一个最佳模型来识别 PAH 患者的风险状况。方法和结果对 70 名 PAH 患者进行了全面的风险评估。每个患者的风险状况都是根据指​​南建议确定的。传统参数，包括面积变化分数 (FAC) 和三尖瓣环平面收缩期偏移 (TAPSE)、新型散斑跟踪衍生的 RV 纵向应变 (RVLS) 和三维 RV 射血分数 (3D-RVEF) 用于评估房车功能。测量压力-应变环以评估 RV 心肌做功，包括 RV 总体无用功 (RVGWW)。通过将 RV 参数与估计的肺动脉收缩压 (PASP) 进行索引来评估 RV-肺动脉耦合。中位年龄为 34 (30-43) 岁，其中 62 名 (88.6%) 患者为女性。 45 名患者被分为低风险组，25 名患者被分为中高风险组。大多数 RV 参数可用于确定风险状况，并在索引到 PASP（包括 FAC/PASP、TAPSE/PASP 和 3D-RVEF/PASP）后表现出显着改善的诊断性能。 RVLS/PASP 显示出最好的性能，曲线下面积为 0.895。在多变量分析（模型 1）中，仅 RVGWW (>90.5 mmHg%)、RVLS (> −16.7%) 和 TAPSE (<17.5 mm) 仍然显着（全部磷< 0.05）。模型 1 的表现优于每一个 RV 参数，曲线下面积明显更大（所有磷< 0.05）。使用模型 2 中的 PASP 索引，RVLS/PASP > −0.275 [比值比 (OR) 20.63，95% 置信区间 (CI) 4.62–92.11，磷< 0.001] 且 RVGWW > 90.5 mmHg%（OR 6.17，95% CI 1.37–27.76，磷= 0.018) 独立识别出较高的风险状况。将 RVGWW 添加到两个模型中确定了识别的增量值（连续净重分类改进 1.058，95% CI 0.639–1.477，磷< 0.001)。结论 在确定 PAH 患者的风险状况方面，RV 功能的组合模型优于任何单一参数。使用多参数方法综合评估 RV-肺动脉耦合对于 PAH 患者具有临床意义。