Pulmonary arterial hypertension patient right heart function evaluation model based on echocardiography

Abstract

The invention discloses a pulmonary arterial hypertension patient right heart function evaluation model based on echocardiography, and is characterized in that the model construction comprises the following steps: S1, screening subjects: selecting pulmonary arterial hypertension patients meeting inclusion standards and exclusion standards; s2, grouping according to different modes; s3, inquiring from a hospital medical record system to obtain epidemiological data and clinical detection indexes of the group-entering patients; then exercise tolerance evaluation is carried out on the patients entering the group; s5, collecting multi-mode echocardiography examination data by adopting an electronic data acquisition mode; s6, performing post-processing analysis on the ultrasonic image; and index introduction: according to processing analysis and statistical analysis results, selecting an optimal 3D-RVFAC value and a tricuspid regurgitation degree value as two indexes, and constructing a pulmonary arterial hypertension patient right heart function evaluation model based on echocardiography. The invention provides a convenient and reliable examination system for clinical management and prognosis evaluation of patients with pulmonary arterial hypertension.

Description

Technical Field

[0001] The present invention relates to the technical field of constructing pathological models, and in particular to an echocardiogram-based right heart function assessment model for patients with pulmonary hypertension. Background Art

[0002] At present, the clinical indicators used to evaluate right heart function are mainly divided into three categories; the first category is clinical indicators, which indirectly reflect right heart function by evaluating the patient's exercise tolerance. Commonly used indicators include the World Health Organization Pulmonary Hypertension Functional Classification (WHO-FC) and six-minute walking distance. The second category is hemodynamic indicators, which reflect right heart function by measuring parameters such as right atrial pressure, right ventricular pressure, and cardiac output through right heart catheter examination; the third category is imaging indicators, which directly evaluate the structure and function of the right ventricle and the work of the myocardium, including cardiac magnetic resonance technology, radionuclide imaging, and echocardiography; among these three categories of indicators, clinical indicators are qualitative or semi-quantitative indicators, and the results are subjective. Although right heart catheter examination is regarded as the "gold standard" for the diagnosis and grading of pulmonary hypertension, its invasiveness makes it difficult to use as a routine clinical examination method; cardiac magnetic resonance imaging and radionuclide imaging cannot be used for routine patient follow-up due to their high cost, long time consumption, isotope radiation and other limitations; echocardiography is a common examination method for non-invasive assessment of cardiac structure and function. It is widely used in clinical practice because of its simple operation and the advantages of safety, economy and repeatability.

[0003] In recent years, the continuous progress and innovation of ultrasound imaging technology has brought new opportunities for more accurate assessment of right heart function. With the help of real-time three-dimensional echocardiography, we can more accurately measure the volume of the right ventricle and its contractile ability, which is quite consistent with the measurement results obtained by magnetic resonance imaging. The speckle tracking technology can capture the dynamic movement of myocardial specks in real time, and then calculate the strain value of the myocardium in multiple directions. This method has shown its incomparable advantages in assessing the myocardial function of specific regions. However, due to the complex structure of the right ventricle and the great influence of its morphology on the load state, a single ultrasound index cannot fully reflect the right heart function of the patient. It is necessary to use multiple indexes and multiple parameters to improve the accuracy and specificity of diagnosis. The introduction of multiple indexes and multiple parameters can improve the efficiency of diagnosis, but the complex index measurement increases the difficulty of clinical use and cannot meet the requirements of rapid and accurate clinical diagnosis. How to solve the contradiction that there are many available and optional evaluation indicators but it is difficult to use them clinically, and to build a simple and reasonable ultrasound right heart function evaluation system without sacrificing monitoring efficiency and reducing the difficulty of clinical use is the key link in evaluating and monitoring the right heart function of patients with pulmonary hypertension.

[0004] Therefore, in order to solve the above problems, this paper proposes a right heart function assessment model for patients with pulmonary hypertension based on echocardiography. Summary of the invention

[0005] The present invention designs a right heart function evaluation model for patients with pulmonary hypertension based on echocardiography, with the aim of selecting optimal parameters to construct a right heart function evaluation model for patients with pulmonary hypertension, so as to provide a convenient and reliable examination system for the clinical management and prognosis evaluation of patients with pulmonary hypertension.

[0006] In order to achieve the above technical effects, the present invention is implemented by the following technical scheme: a right heart function assessment model for patients with pulmonary hypertension based on echocardiography, characterized in that constructing the model includes the following steps:

[0007] S1. Screening of subjects: Select patients with pulmonary hypertension who meet the inclusion and exclusion criteria;

[0008] S2. Grouping by different methods: According to the risk stratification recommendations for pulmonary arterial hypertension (PAH), patients in the PH group were divided into low-risk group, intermediate-risk group, and high-risk group;

[0009] According to the right heart function classification standard, the PH group patients were divided into two groups: PH+non RHF group and PH+RHF group;

[0010] According to whether the outcome events occurred during the 1-year follow-up, the patients were divided into an event group and a no-event group;

[0011] S3. Obtain epidemiological data and clinical test indicators of the enrolled patients from the hospital medical record system; then conduct exercise tolerance assessment on the enrolled patients, including pulmonary hypertension functional classification and 6-minute walking test;

[0012] S4. Collect multimodal echocardiographic data using electronic data acquisition: Collect multimodal echocardiographic data of patients at all stages using conventional echocardiographic image acquisition and three-dimensional echocardiographic image acquisition;

[0013] S5. Post-processing analysis of ultrasound images: import the three-dimensional dynamic images obtained above into Tom Tec analysis software in DICOM format for post-processing analysis and statistical analysis;

[0014] S6. Model construction: According to the results of processing analysis and statistical analysis, the optimal 3D-RVFAC and tricuspid regurgitation degree values ​​were selected as two indicators to construct an echocardiography-based right heart function assessment model for patients with pulmonary hypertension.

[0015] Furthermore, in S1, the inclusion criteria include:

[0016] Sinus rhythm; aged over 18 years; good compliance, agree to participate in this study, and sign the informed consent; suffer from idiopathic pulmonary hypertension or pulmonary hypertension related to connective tissue disease or congenital heart disease with left-to-right shunt or pulmonary hypertension after surgery / intervention or chronic thromboembolic pulmonary hypertension or pulmonary hypertension related to blood system disease or pulmonary hypertension related to left heart disease (LVEF≥50%).

[0017] Furthermore, in S1, the exclusion criteria include:

[0018] Patients with other types of pulmonary hypertension except idiopathic pulmonary hypertension, pulmonary hypertension associated with connective tissue disease, left-to-right shunt congenital heart disease, surgical / interventional pulmonary hypertension, chronic thromboembolic pulmonary hypertension, pulmonary hypertension associated with blood system diseases, and pulmonary hypertension associated with left heart disease (LVEF ≥ 50%); patients with right bundle branch block; patients with mental illness, drug addiction or other medical conditions who are unable to provide informed consent or cannot cooperate with the examination; patients with acute / chronic organic diseases (except dyspnea) that limit them from completing all the tests required for the study; patients with unstable medical conditions; pregnant or breastfeeding patients.

[0019] Furthermore, in S2, the outcome events include all-cause mortality and heart failure rehospitalization events.

[0020] Furthermore, in S5, the statistical analysis was specifically performed by using R software, and a two-sided test result was adopted (test level α=0.05); it was statistically significant when P<0.05.

[0021] The beneficial effects of the present invention are:

[0022] The present invention is based on a prospective cohort study design, and performs multimodal ultrasound detection on various types of clinical patients with pulmonary hypertension to evaluate their right heart function; the optimal parameters are selected to construct a right heart function evaluation model for patients with pulmonary hypertension, so as to provide a convenient and reliable examination system for the clinical management and prognosis evaluation of patients with pulmonary hypertension. BRIEF DESCRIPTION OF THE DRAWINGS

[0023] In order to more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings required for describing the embodiments are briefly introduced below. Obviously, the drawings described below are only some embodiments of the present invention. For ordinary technicians in this field, other drawings can be obtained based on these drawings without creative work.

[0024] Figure 1 It is a flow chart of constructing the evaluation model of the present invention. DETAILED DESCRIPTION

[0025] The following will be combined with the drawings in the embodiments of the present invention to clearly and completely describe the technical solutions in the embodiments of the present invention. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0026] Example 1

[0027] This embodiment describes the construction of a right heart function assessment model for patients with pulmonary hypertension based on echocardiography, which includes the following steps:

[0028] S1. Screening of subjects: The study selected 101 patients with pulmonary hypertension who met the inclusion and exclusion criteria and were treated from July to December 2021. Six patients were excluded due to poor three-dimensional images and loss of follow-up. Finally, 95 patients were included for follow-up analysis. Clinical epidemiological data of enrolled cases were collected, and multimodal echocardiographic parameters were used for diagnostic model construction. All enrolled patients were followed up for 1 year or until the endpoint event occurred. The subjects and their families were clearly informed and signed the consent form;

[0029] S2. Grouping by different methods:

[0030] 1. According to the risk stratification recommendations for pulmonary arterial hypertension (PAH), the PH group patients were divided into low-risk group, intermediate-risk group and high-risk group. The risk stratification recommendations for pulmonary arterial hypertension (PAH) are shown in Table 1 below:

[0031]

[0032] Table 1

[0033] 2. According to the right heart function classification standard, the PH group was divided into two groups: PH+non RHF group and PH+RHF group; according to the right heart function classification standard in the "Chinese Expert Consensus on Diagnosis and Treatment of Right Heart Failure (2012 Edition)", the PH group was divided into two groups: PH+non RHF group and PH+RHF group; the reference standards are as follows:

[0034] 2.1. The presence of possible causes of right heart failure; the most important of which are left heart failure, pulmonary hypertension (including those caused by COPD), right ventricular myocardial disease (including right ventricular infarction, restrictive lesions and ARVC, etc.), right valvular disease and certain congenital heart diseases;

[0035] 2.2. Symptoms and signs of right heart failure; symptoms mainly include decreased activity tolerance, fatigue, and dyspnea; signs mainly include signs of increased jugular venous pressure, liver enlargement, peripheral edema, and a combination of these signs;

[0036] 2.3. Objective evidence of right heart structural and functional abnormalities and increased intracardiac pressure exists. Such evidence mainly comes from imaging examinations, including echocardiography, radionuclide and magnetic resonance imaging. Right cardiac catheterization may provide evidence of increased intracardiac pressure and functional abnormalities.

[0037] 3. According to whether the patients had outcome events during the 1-year follow-up, they were divided into an event group and a no-event group;

[0038] S3. Obtain epidemiological data and clinical test indicators of the enrolled patients from the hospital medical record system; then conduct exercise tolerance assessment on the enrolled patients, including pulmonary hypertension functional classification and 6-minute walking test;

[0039] Among them, clinical epidemiological data specifically include basic information such as ethnicity, age, height, weight, smoking, drinking, occupation, and education level; clinical detection indicators specifically include information such as routine blood tests, blood biochemistry, and myocardial injury markers.

[0040] Among them, the functional classification of pulmonary hypertension is based on the patient's activity tolerance. The standards are shown in Table 2:

[0041]

[0042] Table 2

[0043] The 6-minute walk test is as follows:

[0044] The 6-minute walk test was conducted according to the American College of Chest Physicians guidelines; the test site was set up in a closed corridor in the ward, with a 30-meter walking track, the starting and ending points were marked with straight yellow lines, and a marking point was set every 3 meters; to ensure the accuracy of the test, patients were required to avoid strenuous activities 2 hours before the start of the test;

[0045] Before the experiment, the equipment needed for the experiment, including a timer, a pulse oximeter, an ECG monitor, an oxygen pillow, and an automatic defibrillator, etc., need to be prepared in advance; during the experiment, a nurse is responsible for monitoring the execution and explaining the process and precautions of the experiment to the patient, emphasizing that the patient should walk the farthest distance possible within 6 minutes;

[0046] During the test, if the patient experiences chest pain, unbearable dyspnea, leg cramps, staggering, or sweating, pale or gray complexion, the 6-minute walk test should be stopped immediately; at the end of the test, the tester is required to accurately record the patient's walking time and 6-minute walk distance on the report form.

[0047] S4. Collect multimodal echocardiographic data using electronic data acquisition: Collect multimodal echocardiographic data of patients at all stages using conventional echocardiographic image acquisition and three-dimensional echocardiographic image acquisition;

[0048] Among them, the specific operations of conventional echocardiographic image acquisition are as follows:

[0049] The subject was examined in the left lateral decubitus or supine position, connected to an electrocardiogram, and asked to breathe calmly to improve the quality of image acquisition. Using the S5-1 probe, standard two-dimensional, M-mode, and Doppler ultrasound images were obtained in the parasternal left ventricular long-axis section, the aorta short-axis section, the apical four-chamber section, the three-chamber section, the two-chamber section, the subxiphoid four-chamber section, and the inferior vena cava long-axis section. The dynamic images were stored for at least 4 cardiac cycles;

[0050] The specific operation of three-dimensional echocardiography image acquisition is as follows:

[0051] The subject is examined in the left lateral decubitus or supine position, connected to the electrocardiogram, and asked to breathe calmly. If necessary, they can hold their breath briefly to improve the quality of image acquisition. Use the X5-1 probe, place the probe at the apical four-chamber section, and slightly deflect the probe toward the right ventricular outflow tract to obtain a four-chamber section dominated by the right ventricle. After adjusting the image quality until the endocardium is clearly displayed, click "FULL VOLUME" to enter the three-dimensional mode, adjust the probe frame rate to >20 frames / s, wait until the electrocardiogram displays steadily, and store real-time full-volume dynamic images for at least 4 cardiac cycles for subsequent offline analysis. All section acquisition and numerical measurement comply with the ASE Guidelines for Comprehensive Transthoracic Echocardiography in Adults and the BSE Guidelines for Right Heart Echocardiography Evaluation in Adults.

[0052] S5. Post-processing analysis of ultrasound images: import the three-dimensional dynamic images obtained above into Tom Tec analysis software in DICOM format for post-processing analysis and statistical analysis;

[0053] Among them, the ultrasound image post-processing analysis is as follows:

[0054] (1) Import the 3D dynamic image in DICOM format into Tom Tec analysis software for post-processing analysis; select "4DRV-Function" to enter the analysis interface;

[0055] (2) After manually positioning the mitral valve ring, tricuspid valve ring, and aortic valve ring, the software will automatically generate three horizontal sections (base level, papillary muscle level, and apex level) of the apical four-chamber view, two-chamber view, and parasternal ventricular short-axis tube at the end of diastole and end of systole. The section baseline is adjusted at the end of diastole and end of systole of each section, and the TV baseline is placed at the level of the midpoint of the line connecting the tricuspid valve rings.

[0056] (3) After the software automatically tracks and traces the endocardial line, RVFW-GLS, IVS-GLS, right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), RVEF can be calculated, and a time-volume curve can be obtained. If the endocardial delineation is satisfactory, the right ventricular endocardial boundary can be manually adjusted, tracked, and then the analysis results can be obtained again;

[0057] The statistical analysis is as follows:

[0058] R software (version 4.1.2) was used for the analysis, and the results of two-sided tests were used (test level α = 0.05); P < 0.05 was considered statistically significant; if continuous variables followed a normal distribution, mean ± standard deviation was used to describe them, and the differences between groups were analyzed using two independent sample t-tests; if they did not follow a normal distribution, median (interquartile range) was used to describe them, and the differences between groups were analyzed using Wilcoxon rank sum test; categorical variables were described by number of cases (percentages), and the chi-square test was used to analyze whether the distribution differences of the indicators between the groups were statistically significant; the accuracy and differences of different risk stratification methods in predicting prognosis were compared using receiver operating characteristic (ROC) curve analysis, and the parameters such as sensitivity, specificity and area under the curve (AUC) values ​​of various methods were given, and the differences between different ROC curves were compared using Delong test analysis.

[0059] S6. Model construction: According to the results of processing analysis and statistical analysis, the optimal 3D-RVFAC and tricuspid regurgitation degree values ​​were selected as two indicators to construct an echocardiography-based right heart function assessment model for patients with pulmonary hypertension.

[0060] Example 2

[0061] This example describes whether each factor in each group has statistical significance, as follows:

[0062] The patients were grouped according to the three grouping criteria in the method. The baseline data are as follows

[0063] As shown in Table 3, Table 4 and Table 5;

[0064]

[0065]

[0066] In Table 3 , a: compared with the low-risk group, p < 0.0001; b: compared with the intermediate-risk group, p < 0.0001;

[0067]

[0068] Table ​ Table4 4 a: compared with PH+non RHF group, p < 0.0001;

[0069]

[0070]

[0071] Table 5

[0072] Among the three grouping schemes, there were no significant differences in gender, age, height, and weight of patients, and the differences were not statistically significant; the results of the six-minute walk test in the risk stratification evaluation scheme and the right heart failure evaluation scheme were statistically significant between the groups (P<0.001); in the risk stratification evaluation scheme, the average walking distance of the high-risk group was 225.6m, which was significantly lower than that of the medium-risk group (341.9m), and the average walking distances of the high-risk group and the medium-risk group were significantly lower than that of the low-risk group (439.5m). In the right heart failure evaluation scheme, the average walking distance of the PH+RHF group was 324.1m, which was significantly lower than that of the PH+non RHF group (404.3m). In the experimental evaluation scheme, there was no statistically significant difference in the results of the six-minute walk test between the event-free group and the event group.

[0073] As shown in Table 6, there was no significant difference in the average level / distribution of age, weight, gender, height, systolic blood pressure, diastolic blood pressure, heart rate, body temperature, respiration, 6-minute walk test, and WHO-FC grade between the event group and the event group; there was a significant difference in the average level / distribution of whether peripheral edema was combined and whether diuretics were used in clinical treatment between the two groups (P<0.05);

[0074]

[0075]

[0076] Table 6

[0077] Table 6 a It means that the index does not follow the normal distribution, and the Wilcoxon rank sum test is used to analyze the results.

[0078] As shown in Table 6, the proportion of edema in the event group was 61.54%, significantly higher than 35.71% in the non-event group (P = 0.023); the proportion of diuretics used in the event group was 71.19%, significantly higher than 44.64% in the non-event group (P = 0.016). In addition, the SvO2 analysis results showed that there was a trend difference between the two groups (P = 0.055). Although this result did not reach the traditional statistical significance level, the reduction of SvO2 indicated an imbalance between systemic oxygen delivery and consumption, and was related to right ventricular dysfunction and the severity of the patient's disease.

[0079] As shown in Table 7, there was no statistically significant difference in the average levels / distribution of laboratory test indicators NT pro-BNP, hemoglobin, red blood cells, white blood cells, platelets, HDL, LDL, TGHOL, urea, creatinine, uric acid, CK_MB, MYO, and hs-TNT between the event-free group and the event group.

[0080]

[0081] Table 7

[0082] Table 7 a It means that the index does not follow the normal distribution, and the Wilcoxon rank sum test is used to analyze the results; b Indicates a missing value.

[0083] As shown in Table 8, the results of univariate statistical analysis showed that there was no significant difference in the average level / distribution of left heart structural parameters, such as LVEDd, LVEDs, IVSd, and LVPWd; left heart function parameters, such as LVEF, LVFS, and C1, between the event-free group and the event group, which could not indicate that there were differences in left heart structure and function between the two groups. There was no significant difference in the average level / distribution of right ventricular structural parameters, such as RVDd_base, RVDd_mid, RVDd-length, RVEDA, and RVESA; right ventricular outflow tract parameters, such as RVOTd-PLAX, RVOTd-PSAX, and RVOTd-distal, between the event-free group and the event group, indicating that the effectiveness of right heart structural parameters in distinguishing the characteristics of the two groups was poor.

[0084] The mean level / distribution difference of 3D FAC and tricuspid regurgitation between the event group and the non-event group reached statistical significance (p<0.05). In terms of 3D FAC, the mean level in the event group was 33.42%, which was significantly lower than 38.12% in the non-event group (P=0.019). In terms of severe tricuspid regurgitation, patients in the non-event group had less tricuspid regurgitation, mostly mild and mild-moderate tricuspid regurgitation, while patients in the event group had more tricuspid regurgitation, mostly moderate and severe tricuspid regurgitation. Among them, the proportion of severe tricuspid regurgitation in the event group was 43.59%, which was significantly higher than 7.14% in the non-event group (P<0.001). In addition, although the mean level / distribution differences of the three parameters RAESA (P=0.064), TAPSE (P=0.094), and IVCD (P=0.103) between the event-free group and the event group did not reach the traditional statistical significance level, it was observed that RAESA and IVCD were higher in the event group than in the event-free group, and TAPSE was lower in the event group than in the event-free group, indicating that the event group had worse right ventricular systolic function, heavier volume load, and possible right atrial remodeling than the event-free group.

[0085]

[0086]

[0087] Table 8

[0088] As shown in Table 9, the chi-square test results showed that there was no statistically significant difference in the distribution ratios of the event group and the non-event group in the risk stratification evaluation scheme and the right heart failure evaluation scheme; therefore, it cannot be concluded that the proportions of the event group and the non-event group in the low-risk, intermediate-risk, and high-risk groups of the risk stratification evaluation scheme are different; similarly, it cannot be concluded that the proportions of the event group and the non-event group in the PH-nonRHF group and PH+RHF group in the right heart failure evaluation scheme are different (p=0.259); both traditional evaluation methods cannot effectively distinguish patients with poor clinical prognosis.

[0089]

[0090]

[0091] Table 9

[0092] As shown in Table 10, the multivariate logistic regression model fitting and analysis results of different prognostic groups (low-risk group, high-risk group) are as follows:

[0093] The variables with statistical significance in the univariate analysis were further included in the multivariate logistic regression model analysis. Finally, 94 samples with no missing variables were included (55 in the non-event group and 39 in the event group). The forward stepwise independent variable screening method was used. According to the principle of optimal Akaike information criterion (AIC), only 3D RVFAC and tricuspid regurgitation degree were retained in the optimal logistic regression model. The optimal logistic regression model can be expressed by the following formula:

[0094] Logit(P)=-0.481-0.045×3D RVFAC+0.446×tricuspid regurgitation degree

[0095] Table 10

[0096] The results of multivariate statistical analysis showed that only the severity of tricuspid regurgitation was an independent influencing factor for poor prognosis of patients (p<0.05); among them, with each increase in the degree of tricuspid regurgitation, the prognostic risk increased by 1.563 times (OR=1.563, 95%CI: 1143-2.188).

[0097] In summary, the three grouping schemes have the effects on the evaluation of right heart function in patients with pulmonary hypertension as shown in Table 11;

[0098]

[0099] Table 11

[0100] In summary, this study constructed a right heart function evaluation model that includes two indicators, 3D RVFAC and tricuspid regurgitation degree; by comparing with the risk stratification evaluation scheme and the right heart failure evaluation scheme, the effectiveness of the model was confirmed. This provides a new evaluation method for routine clinical monitoring of right heart function in patients with pulmonary hypertension.

Claims

1. A right heart function assessment model for patients with pulmonary hypertension based on echocardiography, characterized in that: Building the model involves the following steps: S1. Screening of subjects: Select patients with pulmonary hypertension who meet the inclusion and exclusion criteria; S2. Grouping by different methods: According to the risk stratification recommendations for pulmonary arterial hypertension (PAH), patients in the PH group were divided into low-risk group, intermediate-risk group, and high-risk group; According to the right heart function classification standard, the PH group patients were divided into two groups: PH+non RHF group and PH+RHF group; According to whether the outcome events occurred during the 1-year follow-up, the patients were divided into an event group and a no-event group; S3. Obtain epidemiological data and clinical test indicators of the enrolled patients from the hospital medical record system; then conduct exercise tolerance assessment on the enrolled patients, including pulmonary hypertension functional classification and 6-minute walking test; S4. Collect multimodal echocardiographic data using electronic data acquisition: Collect multimodal echocardiographic data of patients at all stages using conventional echocardiographic image acquisition and three-dimensional echocardiographic image acquisition; S5. Post-processing analysis of ultrasound images: import the three-dimensional dynamic images obtained above into Tom Tec analysis software in DICOM format for post-processing analysis and statistical analysis; S6. Model construction: According to the results of processing analysis and statistical analysis, the optimal 3D-RVFAC and tricuspid regurgitation degree values ​​were selected as two indicators to construct an echocardiography-based right heart function assessment model for patients with pulmonary hypertension.

2. The right heart function assessment model for patients with pulmonary hypertension based on echocardiography according to claim 1, characterized in that: In S1, the inclusion criteria include: Sinus rhythm; aged over 18 years; good compliance, agree to participate in this study, and sign the informed consent; suffer from idiopathic pulmonary hypertension or pulmonary hypertension related to connective tissue disease or congenital heart disease with left-to-right shunt or pulmonary hypertension after surgery / intervention or chronic thromboembolic pulmonary hypertension or pulmonary hypertension related to blood system disease or pulmonary hypertension related to left heart disease (LVEF≥50%).

3. The right heart function assessment model for patients with pulmonary hypertension based on echocardiography according to claim 2, characterized in that: In S1, the exclusion criteria include: Patients with other types of pulmonary hypertension except idiopathic pulmonary hypertension, pulmonary hypertension associated with connective tissue disease, left-to-right shunt congenital heart disease, surgical / interventional pulmonary hypertension, chronic thromboembolic pulmonary hypertension, pulmonary hypertension associated with blood system diseases, and pulmonary hypertension associated with left heart disease (LVEF ≥ 50%); patients with right bundle branch block; patients with mental illness, drug addiction or other medical conditions who are unable to provide informed consent or cannot cooperate with the examination; patients with acute / chronic organic diseases (except dyspnea) that limit them from completing all the tests required for the study; patients with unstable medical conditions; pregnant or breastfeeding patients.

4. The right heart function assessment model for patients with pulmonary hypertension based on echocardiography according to claim 1, characterized in that: In S2, the outcome events include all-cause mortality and heart failure rehospitalization.

5. The right heart function assessment model for patients with pulmonary hypertension based on echocardiography according to claim 1, characterized in that: In S5, the statistical analysis was specifically performed by using R software, and two-sided test results were used (test level α=0.05); it was statistically significant when P<0.05.

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