Abstract
BackgroundIn patients with pulmonary artery hypertension (PAH), right ventricular pressure overload eventually causes right heart failure (RHF), leading to a poor prognosis. Right atrial (RA) overload and RA dysfunction occur in patients with PAH-complicated RHF.ObjectivesWe evaluated RA function using right atrial longitudinal strain (RALS) by two-dimensional speckle tracking echocardiography (2D-STE) and investigated the association between RALS and the severity of RHF in patients with pulmonary artery hypertension (PAH) noninvasively.MethodsWe performed 2D-STE in 56 PAH patients and 20 normal control subjects. The peak global RALS and peak global RA longitudinal strain rate (RALSR) were analyzed by 2D-STE. Simultaneous right heart catheterization was performed to determine the right atrial pressure (RAP) and cardiac index (CI).ResultsPeak global RALS (34.6 ± 14.1 vs. 58.3 ± 9.9 %, p < 0.0001) and peak global RALSR (2.5 ± 1.3 vs. 3.1 ± 1.2 s−1, p < 0.0001) were significantly lower in PAH patients compared with normal controls. There was a significant negative correlation between peak global RALS and RAP (r = −0.8037, p < 0.0001). There was a significant positive correlation between peak global RALS and CI (r = 0.8179, p < 0.0001). Peak global RALSR was also correlated with RAP (r = −0.7308, p < 0.0001) and CI (r = 0.7596, p < 0.0001).ConclusionsRALS and RALSR by 2D-STE were useful for noninvasive evaluation of RA dysfunction and the severity of RHF in patients with PAH.
Highlights
In patients with pulmonary artery hypertension (PAH), the pulmonary vascular resistance (PVR), pulmonary artery pressure (PAP), and right ventricular (RV) afterload are all increased
right atrial longitudinal strain (RALS) and RA longitudinal strain rate (RALSR) by 2D-STE were useful for noninvasive evaluation of Right atrial (RA) dysfunction and the severity of right heart failure (RHF) in patients with PAH
HR heart rate, BNP brain natriuretic peptide, PAP pulmonary artery pressure, PCWP pulmonary capillary wedge pressure, PVR pulmonary vascular resistance, RAP right atrial pressure, Cardiac output (CO) cardiac output, CI cardiac index p \ 0.0001) and right ventricular end-systolic area index (RVESAI) (12.3 ± 5.9 vs. 5.8 ± 1 cm2/m2, p \ 0.0001) were significantly larger in the PAH patients compared with the normal controls, while the right ventricular fractional area change (%RVFAC) (34.4 ± 10.5 vs. 50.5 ± 6.5 %, p \ 0.0001) was significantly smaller
Summary
In patients with pulmonary artery hypertension (PAH), the pulmonary vascular resistance (PVR), pulmonary artery pressure (PAP), and right ventricular (RV) afterload are all increased. The increase of RV afterload causes RV dilatation and hypertrophy, and impaired compliance of the hypertrophied and dilated RV contributes to a further increase of RV end-diastolic pressure and right atrial pressure (RAP), eventually leading to right heart failure (RHF) and a poor prognosis. RAP and the cardiac index (CI) are parameters with established usefulness for assessing the severity of RHF and prognosis of PAH patients [1]. Assessment of RA overload and RA dysfunction has important implications for evaluating the severity of RHF in the management of patients with PAH. IVC-based estimates of RAP are less reliable than invasive values. In patients with pulmonary artery hypertension (PAH), right ventricular pressure overload eventually causes right heart failure (RHF), leading to a poor prognosis. Right atrial (RA) overload and RA dysfunction occur in patients with PAH-complicated RHF
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