Utilizing Three-Dimensional Right Ventricular Free-Wall Strain to Distinguish a Subgroup with Elevated Doppler-Estimated Pulmonary Artery Systolic Pressure in High-Altitude Heart Disease

By
Li Cui
Xiyi Lu
Zihan Xu
Chunrui Zhou
Lei Zhong
Qingyi Luo
Qinghui Wang
July 9, 2026

Frontiers In Cardiovascular Medicine

Objective:

To determine whether three-dimensional speckle-tracking-derived right ventricular free-wall longitudinal strain (absolute RVFWLS) better identifies a subgroup of patients with elevated Doppler-estimated pulmonary artery systolic pressure (PASP ≥60 mmHg) within high-altitude heart disease (HAHD) compared to TAPSE.

Approach:

Study Design: Retrospective study involving 100 participants (40 controls, 60 HAHD patients) who underwent standardized echocardiography.
Subgroup Classification: Patients with HAHD were categorized into higher-PASP (PASP ≥60 mmHg) and lower-PASP (PASP <60 mmHg) subgroups.
Statistical Analysis: ROC curves were compared using paired DeLong tests; logistic models evaluated absolute RVFWLS beyond TAPSE, age, and sex.

Key Findings:

Absolute RVFWLS showed better discrimination than TAPSE for identifying the higher-PASP subgroup, with ROC AUC values of 0.886 and 0.647, respectively (P = 0.002).
Incorporating absolute RVFWLS into the model with TAPSE, age, and sex significantly improved model fit (likelihood-ratio P < 0.001).
RV-ESV accounted for 45.0% of the PASP–3D-EF association but did not materially account for the PASP–absolute RVFWLS association.

Interpretation:

Three-dimensional absolute RVFWLS is more effective than TAPSE in identifying higher-PASP subgroups in HAHD.

Limitations:

Findings are exploratory and require prospective validation against invasive hemodynamic measurements.
Study is retrospective and may be subject to selection bias.