Background: Our aim was to compare three‐dimensional (3D) and 2D and 3D speckle‐tracking (2D‐ STE , 3D‐ STE ) echocardiographic parameters with conventional right ventricular ( RV ) indexes in patients with chronic pulmonary hypertension ( PH ), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure. Methods and Results: Seventy‐three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements ( RV –fractional area change–tricuspid annular plane systolic excursion) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes and global and regional ejection fraction (3D‐ RVEF ) were determined. RV strains were calculated by 2D‐ STE and 3D‐ STE . RV 3D global‐free‐wall longitudinal strain (3D GFW ‐ RVLS ), 2D global‐free‐wall longitudinal strain ( GFW ‐ RVLS ), apical‐free‐wall longitudinal strain, basal‐free‐wall longitudinal strain, and 3D‐ RVEF were lower in patients with precapillary PH ( P <0.0001) and postcapillary PH ( P <0.01) compared to controls. 3D GFW ‐ RVLS (hazard ratio 4.6, 95% CI 2.79 to 8.38, P =0.004) and 3D‐ RVEF (hazard ratio 5.3, 95% CI 2.85 to 9.89, P =0.002) were independent predictors of mortality. Receiver operating characteristic curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D‐ RVEF ( AUC 0.89), −17% for 3D GFW ‐ RVLS ( AUC 0.88), −18% for GFW ‐ RVLS ( AUC 0.88), −16% for apical‐free‐wall longitudinal strain ( AUC 0.85), 16 mm for tricuspid annular plane systolic excursion ( AUC 0.67), and 38% for RV ‐ FAC ( AUC 0.62). Conclusions: In chronic PH , 3D, 2D‐ STE and 3D‐ STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices.

Background Aortic stiffness may be associated with an increased incidence of cardiovascular events and has been reported to be related to arterial wall motion velocities as measured by tissue Doppler imaging. Objective To investigate the potential clinical application of tissue Doppler imaging (TDI) for assessment of aortic function parameters in healthy and hypertensive adults. Methods 110 hypertensive and 80 healthy adults were examined. Pulse wave velocity (PWV) and augmentation index (Aix) were measured as standard parameters of arterial stiffness by an oscillometric system. Aortic M-mode and TDI parameters were measured. Aortic distensibility (D) and aortic stiffness index (SI) were calculated using accepted formulae. Anterior wall aortic expansion velocity (S_Ao), acceleration time (AT_Ao), early (E_Ao) and late (A_Ao) diastolic retraction velocity and peak systolic radial strain (ε_Ao) were determined. Comprehensive echocardiography was performed for the assessment of left ventricular (LV) systolic/diastolic function. Results S_Ao, E_Ao and e_Ao were significantly lower in hypertensive subjects (p<.001, p<.001, and p<.0001, respectively). Reduced D (p<.05 vs controls) and increased PWV (p<.05 vs controls) and SI (p<.01 vs controls) were consistent with evidence of increased aortic stiffness in both male and female hypertensive patients. PWV and Aix increased and D decreased with increasing age or systolic blood pressure. Multivariate analysis showed ε_Ao to be independently related (R2 = 0.63) to pulse pressure, LV mass index and diastolic function. Conclusion Ascending aorta TDI provides wall velocity and strain data differentiating hypertensive from healthy adults and reflecting aortic compliance changes related to age and sex and LV diastolic function.