Abstract TH301: 2 Dimensional Echocardiography versus 3 Dimentional Echocardiography to Assess Right Ventricular Function in Pulmonary Hypertension: A Systematic Review

Introduction: Pulmonary Hypertension (PH) requires Right Ventricular (RV) function assessment for its management. The most common imaging used is Two-dimensional echocardiography (2DE), which has its limitations in evaluating RV function, whereas Three-dimensional echocardiography (3DE) offers a more accurate evaluation of RV structure and function with improved diagnostic and prognostic capabilities. Objective: To systematically evaluate the comparative accuracy and clinical utility of 3DE versus 2DE in assessing RV parameters in PH. Methodology: A systematic review was performed following PRISMA guidelines. A total of 10 studies met the inclusion criteria. Results: In our review, a total of 10 studies were included with enrolment of 599 adult patients diagnosed with PH of various types. Sample sizes ranged from 13 to 103 participants per study. The mean age across the studies ranged from late 40s to mid-60s. Across all studies, RV functional parameters were quantitatively assessed using both 3DE and 2DE modalities. Major parameters included were, RV end-diastolic volume (RVEDV) which ranged from 84.7-259 ml in 3DE compared to 49.9-104 ml in 2DE, end-systolic volume (RVESV) 81.7-198 ml with 3DE v/s 24-48 ml with 2DE, RV ejection fraction (RVEF) 25%-40% in 3DE versus 50%-55% with 2DE, and RV longitudinal strain (RVLS) ranged from -6.2% - -22.4% in 3DE versus -11.7% - -28% in 2DE. From our outcomes, we analyzed that 3DE provided more accurate evaluation of RV volumes and functions. The reduced functional capabilities in PH patients proved 3DE’s higher sensitivity of detection for risk of RV failure, improved consistency in volumetric measurements without geometrical assumptions compared to 2DE. 3DE and cardiac magnetic resonance imaging (CMR) showed close enough measurements of RVEDV, RVESV and RVEF. None of the included studies reported major technical complications or adverse events associated with either imaging modality, indicating that 3DE is both effective and safe for clinical use in the PH population. Conclusion: 3DE has superior diagnostic and prognostic capabilities over 2DE in the assessment of RVF in PH patients and should be advised as common practice for detailed status of PH control and management.