Right Ventricular Remodeling Using Three-Dimensional Echocardiography in Pediatric Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: A Case–Control Study
- 1Department of Pediatrics III, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
- 2Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation, 540139 Târgu Mureş, Romania
- 3Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
Abstract
Background: Three-dimensional echocardiography (3DE) enables comprehensive assessment of right ventricular (RV) remodeling, but its role in children with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) remains incompletely characterized. Methods: In the current case–control study, eleven children with catheterization-confirmed PAH-CHD and 50 healthy controls underwent conventional, three-dimensional, and speckle-tracking echocardiography. Three-dimensional RV geometry and function were compared between groups, and their discriminative performance and relationships with conventional and deformation indices were evaluated. Results: Children with PAH-CHD showed increased RV volumes and transverse dimensions, reduced longitudinal dimension, and impaired systolic function compared with controls (all adjusted p < 0.05). RV fractional area change (RV_FAC_3D) and RV ejection fraction (RV_EF_3D) measured by 3DE demonstrated acceptable-to-good discriminative performance (AUC = 0.88, 95% CI: [0.73,1] and AUC = 0.85, 95% CI: [0.70,1], respectively), whereas 3D tricuspid annular plane systolic excursion (RV_TAPSE_3D) and RV_SV_3D did not achieve significant discrimination after correction for multiple comparisons. After controlling for PAH-CHD duration, significant partial Pearson correlations were observed between RV end-systolic volume (RV_ESV_3D) and left ventricular end-diastolic mass (LV_ED_mass_3D): partial r = 0.85, p = 0.0017, p-corrected = 0.012, LV_ED_mass_3D: RV_SV_3D and RV_Ld_3D were both negatively correlated with LV_AIS (partial r = −0.81, p = 0.0042 and partial r = −0.85, p = 0.0016, respectively p-corrected = 0.0352). Conclusions: Most 3D indices discriminated PAH-CHD from controls with acceptable-to-good accuracy. RV volumetric and functional indices correlated broadly with conventional 2D and diastolic Doppler parameters, with LV geometry and segmental mechanics, and, more selectively, with right atrial contractile strain although not all correlations remained significant after correction for multiple comparison. These exploratory findings suggest that 3DE may complement conventional echocardiography in the multiparametric assessment of pediatric PAH-CHD.
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BibTeX
@article{șuteu2026right,
title = {{Right Ventricular Remodeling Using Three-Dimensional Echocardiography in Pediatric Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: A Case–Control Study}},
author = {Carmen Corina Șuteu and Amalia Făgărăşan and Liliana Gozar and Iolanda Muntean and Nicola Şuteu and Daniela Toma and Ana Sorina Paşc and Cristina Blesneac and Laura Beligan and Andreea Cerghit-Paler and Diana Ramona Iurian and Mihaela Iancu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218524},
url = {https://www.mdpi.com/2077-0383/15/21/8524},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Right Ventricular Remodeling Using Three-Dimensional Echocardiography in Pediatric Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: A Case–Control Study
AU - Carmen Corina Șuteu
AU - Amalia Făgărăşan
AU - Liliana Gozar
AU - Iolanda Muntean
AU - Nicola Şuteu
AU - Daniela Toma
AU - Ana Sorina Paşc
AU - Cristina Blesneac
AU - Laura Beligan
AU - Andreea Cerghit-Paler
AU - Diana Ramona Iurian
AU - Mihaela Iancu
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218524
UR - https://www.mdpi.com/2077-0383/15/21/8524
AB - Background: Three-dimensional echocardiography (3DE) enables comprehensive assessment of right ventricular (RV) remodeling, but its role in children with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) remains incompletely characterized. Methods: In the current case–control study, eleven children with catheterization-confirmed PAH-CHD and 50 healthy controls underwent conventional, three-dimensional, and speckle-tracking echocardiography. Three-dimensional RV geometry and function were compared between groups, and their discriminative performance and relationships with conventional and deformation indices were evaluated. Results: Children with PAH-CHD showed increased RV volumes and transverse dimensions, reduced longitudinal dimension, and impaired systolic function compared with controls (all adjusted p < 0.05). RV fractional area change (RV_FAC_3D) and RV ejection fraction (RV_EF_3D) measured by 3DE demonstrated acceptable-to-good discriminative performance (AUC = 0.88, 95% CI: [0.73,1] and AUC = 0.85, 95% CI: [0.70,1], respectively), whereas 3D tricuspid annular plane systolic excursion (RV_TAPSE_3D) and RV_SV_3D did not achieve significant discrimination after correction for multiple comparisons. After controlling for PAH-CHD duration, significant partial Pearson correlations were observed between RV end-systolic volume (RV_ESV_3D) and left ventricular end-diastolic mass (LV_ED_mass_3D): partial r = 0.85, p = 0.0017, p-corrected = 0.012, LV_ED_mass_3D: RV_SV_3D and RV_Ld_3D were both negatively correlated with LV_AIS (partial r = −0.81, p = 0.0042 and partial r = −0.85, p = 0.0016, respectively p-corrected = 0.0352). Conclusions: Most 3D indices discriminated PAH-CHD from controls with acceptable-to-good accuracy. RV volumetric and functional indices correlated broadly with conventional 2D and diastolic Doppler parameters, with LV geometry and segmental mechanics, and, more selectively, with right atrial contractile strain although not all correlations remained significant after correction for multiple comparison. These exploratory findings suggest that 3DE may complement conventional echocardiography in the multiparametric assessment of pediatric PAH-CHD.
SN - 2077-0383
ER -