Right Atrial Volume Research Articles

Effect of Bi-Atrial Size and Function in Patients With Paroxysmal or Permanent Atrial Fibrillation

Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 ± 5.6 ml/m2, and the mean RA volume index was 71.0 ± 21.6 ml/m2. Mean LA reservoir strain was 24.3 ± 15.1%, compared with the mean RA reservoir strain of 21.6 ± 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p <0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m2 vs 36.9 [IQR 30.1 to 47.1] ml/m2, p=0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy.

Right atrial function and fibrosis in relation to successful atrial fibrillation ablation.

Bi-atrial remodelling in patients with atrial fibrillation (AF) is rarely assessed and data on the presence of right atrial (RA) fibrosis, the relationship between RA and left atrial (LA) fibrosis, and possible association of RA remodelling with AF recurrence after ablation in patients with AF is limited. A total of 110 patients with AF undergoing initial pulmonary vein isolation (PVI) were included in the present study. All patients were in sinus rhythm during cardiac magnetic resonance (CMR) imaging performed prior to ablation. LA and RA volumes and function (volumetric and feature tracking strain) were derived from cine CMR images. The extent of LA and RA fibrosis was assessed from 3D late gadolinium enhancement images. AF recurrence was followed up for 12 months after PVI using either 12-lead electrocardiograms or Holter monitoring. Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (interquartile range: 122-286) days. RA remodelling parameters were not significantly different between patients with and without AF recurrence after ablation, whereas LA remodelling parameters were different (volume, emptying fraction, and strain indices). LA fibrosis had a strong correlation with RA fibrosis (r = 0.88, P < 0.001). Both LA and RA fibrosis were not different between patients with and without AF recurrence. This study shows that RA remodelling parameters were not predictive of AF recurrence after AF ablation. Bi-atrial fibrotic remodelling is present in patients with AF and moreover, the amount of LA fibrosis had a strong correlation with the amount of RA fibrosis.

Right Heart Structure and Function in Lifelong Recreational Endurance Athletes with and without Paroxysmal Atrial Fibrillation

Healthy young athletes adapt to the increased demands of endurance exercise with symmetric cardiac remodeling. Male veteran endurance athletes have an increased risk for atrial fibrillation (AF), and some athletes seem susceptible to changes mimicking arrhythmogenic cardiomyopathy. Intense exercise puts a disproportionate hemodynamic load on the right-sided heart chambers. Despite this, data describing right heart structure and function in older veteran athletes are scarce. The aim of this study was to investigate structural and functional characteristics of the right heart in veteran athletes with and without AF to contribute to the understanding of exercise-induced cardiac remodeling in this group. Three hundred two male participants, of whom 151 were veteran skiers (62 with paroxysmal AF) and 151 were control subjects from the general population (62 with paroxysmal AF), underwent echocardiographic examinations in sinus rhythm to evaluate right atrial (RA) and right ventricular (RV) structure and function. While 87 of the participants had never exercised regularly, 50, 43, and 122 men had practiced regular endurance exercise for 1 to 20, 20 to 40, and >40years, respectively. RA volume and RV size increased with cumulative years of exercise (P<.001), with a disproportionate increase in RV size compared with left ventricular (LV) size, regardless of AF status (P<.001). RA and RV function assessed by strain remained similar despite lifelong exposure to endurance exercise. AF was associated with reduced RA strain irrespective of exposure to exercise (P<.001). RA and RV sizes and RV/LV ratio showed a dose-response relationship with cumulative years of endurance exercise, whereas RA and RV function did not, indicating that increasing RV/LV ratio may represent a physiologic adaptation to prolonged endurance exercise. AF was associated with reduced RA function, regardless of exposure to exercise, suggesting that RA functional parameters are more closely linked to AF than RA size in veteran athletes.

Prognostic value of right atrial stiffness in systemic sclerosis.

We hypothesised that right atrial (RA) size and mechanics may have prognostic role in systemic sclerosis (SSc) patients without manifest pulmonary arterial hypertension (PAH), thus we aimed to investigate the prognostic power of RA volume, strain and stiffness parameters alone and when added to the echocardiographic marker of RV longitudinal systolic function. Seventy SSc patients (57±12 years) were enrolled into our follow-up study. They underwent standard echocardiographic and tissue Doppler measurements at baseline. In addition to maximal RA volume index, RA reservoir, conduit and contractile strain were measured with 2D speckle tracking technique. RA stiffness was calculated as ratio of TriE/e' to reservoir strain. Survival was assessed after 5 years. All-cause mortality was chosen as outcome. Sequential χ2 analysis was used to evaluate the incremental prognostic benefit of adding RA volume, strain or stiffness to tricuspid S (TriS). During the follow-up period of 4.7±0.9 years, 6 patients (8.6%) died. When added to TriS in sequential Cox model, RA stiffness significantly improved the diagnostic performance of the model (Δχ2= 3.950; p=0.047) and remained independent predictor of the outcome (HR 2.460 (1.005-6.021); p=0.049). Vmax index and strain parameters did not show incremental prognostic value over TriS. Using ROC analysis, RA stiffness ≥0.156 was the best predictor of mortality (sensitivity=83.3%, specificity =89.1%, AUC=0.859). RA stiffness is associated with all-cause mortality in SSc patients without PAH independent of and incremental to the RV longitudinal systolic function. It may be proposed as non-invasive marker for identifying patients with high mortality risk.

Tricuspid Annular Abnormalities in Isolated Left Ventricular Non-compaction-Insights From the Three-dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study.

IntroductionProminent trabecular left ventricular (LV) meshwork and deep intertrabecular LV recesses are featuring LV non-compaction (LVNC). The aim of this study was to evaluate tricuspid annular (TA) morphological and functional abnormalities by three-dimensional speckle-tracking echocardiography (3DSTE) in patients with LVNC without right ventricular (RV) involvement.Materials and MethodsThis study consisted of 21 patients with isolated LVNC, from which 6 cases were excluded due to inferior image quality. The remaining patient group consisted of 15 subjects with a mean age of 52.1 ± 11.4 years (9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4 ± 3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination was performed in all the patients with isolated LVNC and healthy controls. End-systolic and end-diastolic TA dimensions were assessed on selected planes derived from full-volume 3D echocardiographic datasets during 3DSTE.ResultsPatients with isolated LVNC showed significantly dilated end-systolic and end-diastolic TA diameter and area, which were accompanied with preserved TA functional properties and associated with right atrial (RA) volumes. TA plane systolic excursion (TAPSE) showed mild correlations with TA fractional area change (TAFAC) and TA fractional shortening (TAFS). No correlations could be demonstrated between TAPSE and TA morphological features. Extent of LVNC did not correlate with any echocardiographic parameters.ConclusionTA is dilated with preserved sphincter-like function in patients with isolated LVNC. Longitudinal (TAPSE) and sphincter-like (TAFAC and TAFS) TA movements correlate with each other. TA dilation is associated with an increased RA volumes respecting cardiac cycle.

C4 PERMANENT HIS BUNDLE PACING USING STYLET–DRIVEN LEAD IN PATIENTS WITH RIGHT ATRIOMEGALY: A SINGLE–CENTER EXPERIENCE

Abstract Background His bundle pacing (HBP) is becoming an increasing widespread approach for physiological pacing. However, successful HBP procedure could be hampered by limited implantation tools especially in challenging anatomies. We aimed to report our experience with HBP technique using a novel stylet–driven lead system in patients with right atriomegaly. Methods Consecutive patients with right atrium (RA) volume &amp;gt;25 mL/m2 in men and &amp;gt;21 mL/m2 in women who underwent permanent HBP for standard indications were enrolled from March 2020 to March 2021. The tool of first choice for HBP attempt was a stylet–driven lead (Solia S 60, Biotronik) delivered via a dedicated introducer sheath (Selectra 3D, Biotronik). The acute, 1–month and 6–month procedural success rate was assessed. Results We enrolled 24 patients (median age 75 [70–79] years, 85% men) with an average RA volume of 50.7±7.8 mL/m2. At implant, conduction system pacing using stylet–driven lead was achieved in 21 patients (87%): 12 (50%) selective HBP, 6 non–selective HBP (25%) and 3 left bundle branch area pacing (12.5%). In the 3 failures, HBP was further attempted with a different system with final procedural success in 2 cases. In the successful cases, there was a significant reduction of QRS duration between paced and spontaneous beats (152.5 (130–167.5) ms vs 130 (122.5– 137.5) ms, p = 0.003). No lead dislodgment nor significant pacing threshold increase was observed at 1–month (1.30±0.76 V@0.4 vs. 1.32±0.80 V@0.4ms, p &amp;gt; 0.9) and 6–month follow–up (1.30±0.76 V@0.4 vs. 1.38±0.97 V@0.4ms, p = 0.66). Conclusions In our experience, the novel stylet–driven lead system showed high implant success rates and capture threshold stability also in patients with right atriomegaly.

Right atrial function in veteran endurance athletes with paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): A PhD grant from the DAM foundation and a grant from the Raagholt foundation Background Prolonged endurance exercise increases the risk of atrial fibrillation (AF) in middle-aged and older men, but the pathophysiology of AF in otherwise healthy athletes remains elusive. High-intensity endurance exercise puts an extreme load on the right side of the heart and has been associated with a reduction in right atrial (RA) function immediately following exertion. Prolonged endurance exercise impacts long-term remodeling of the RA and might favor the development of arrhythmias. Despite this fact, data regarding RA structure and function in older veteran athletes with prolonged exposure to endurance exercise is scarce. Purpose To describe RA volumes and function assessed by strain in a large cohort of male veteran cross-country skiers with and without AF, compared with age-matched controls with and without AF. Methods A total of 302 study participants, veteran skiers with paroxysmal AF (n=62), veteran skiers without AF (n=89), and controls from a non-athletic population with (n=62) and without paroxysmal AF (n=89), underwent an echocardiographic examination in sinus rhythm to evaluate RA structure and function. The skiers were former participants in the annual 54-kilometer cross-country ski race Birkebeinerrennet regarded as one of the most challenging cross-country ski-races globally. We conducted a two-way between-groups analysis of variance to explore the main effects of athletic status, AF status, and the interaction between AF status and athletic status in echocardiographic parameters. Results The athletes (mean age 70.8±6.7 years) reported an average of 16 completed annual Birkebeinerrennet races and 40-50 years of regular endurance exercise. RA and right ventricular volumes were considerably larger in athletes. RA and right ventricular function assessed by right ventricular free wall longitudinal strain, RA reservoir, conduit, and contractile strain were similar between athletes and non-athletes. Both AF groups had larger RA volumes and lower RA strain values regardless of athletic status. Conclusion RA function was similar in veteran cross-country skiers and controls despite prolonged exposure to endurance exercise with significantly larger RA volumes among athletes. Individuals with AF had lower RA strain parameters than those without AF, regardless of athletic status. RA volumes were associated with both athletic and AF status, and cardiorespiratory fitness needs to be considered when evaluating RA volumes. These findings suggest RA strain to be more closely linked to AF than RA volumes in male veteran endurance athletes.

Application values of right atrial volume, myocardial strain and strain rate in evaluating right atrial function in patients with essential hypertension with normal left ventricular ejection fraction

Objective: To explore the application values of right atrial (RA) volume, myocardial strain and strain rate in evaluating right atrial functions in patients with essential hypertension (EHT) with normal left ventricular ejection fraction (LVEF). Methods: We retrospectively collected a total of 126 EHT patients with normal LVEF, including 66 males and 60 females, age from 18 to 83(48±15) years from the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University from March, 2018 to May, 2020. According to the left ventricular mass index, those patients were divided into without left ventricle hypertrophy (LVH) group (n=66) and LVH group (n=60), and 83 healthy volunteers were enrolled as control group, which including 42 males and 41 females, age from 14 to 88 (48±16) years. The total, passive and active RA emptying fraction (total RAEF, passive RAEF and active RAEF) were measured by using RA volumes method. The RA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump) were measured by two-dimensional speckle tracking echocardiography. Total RAEF, S-reservoir, and Sr-reservoir represented the reservoir function, while passive RAEF, S-conduit, and Sr-conduit represented the conduit function, and active RAEF, S-booster pump and Sr-booster pump represented the booster pump function, respectively. Than the values between the EHT patients and normal subjects, and the values among the EHT patients without LVH, EHT patients without LVH and normal subjects were compared. Results: The value of active RAEF was significantly lower in EHT patient than normal controls (40.1%±10.5% vs 45.4%±11.1%,P=0.001). There were significant differences among EHT patients without LVH, EHT patients with LVH and normal subjects in passive RAEF and active RAEF (passive RAEF: 40.2%±9.3% vs 36.4%±10.7% vs 36.5%±9.4%, P=0.038, active RAEF: 39.8%±10.6% vs 40.4%±10.4% vs 45.4%±11.1%, P=0.002). There were significant differences in S-reservoir, S-conduit, S-booster pump, SR-reservoir, SR-conduit and SR-booster pump between EHT patients and normal subjects [S-reservoir: 34.8%±13.7% vs 45.0%±13.3%, S-conduit: 18.3%±9.4% vs 26.5%±9.6%, S-booster pump: 16.4%±7.3% vs 18.6%±7.1%, SR-reservoir: (1.6±0.6)/s vs (2.0±0.6)/s, SR-conduit: (-1.2±0.5)/s vs (-1.6±0.6)/s, SR-booster pump: (-1.7±0.6)/s vs (-2.3±0.6)/s; all P<0.05]. The trend tests showed normal controls achieved the largest the absolute values of S-reservoir, S-conduit, SR-reservoir, SR-conduit, SR-booster pump, followed by EHT patients without LVH and EHT patients with LVH(all P<0.001). Conclusions: Using RA volume, myocardial strain and strain rate can detect the RA impaired reservoir, conduit, and the booster pump functions in EHT patients with normal LVEF, and the RA functions were damaged more significantly in EHT patients with LVH.

Reference Values for Pediatric Atrial Volumes Assessed by Steady-State Free-Precession Magnetic Resonance Imaging Using Monoplane and Biplane Area-Length Methods.

Measurement of atrial volumes by MRI is becoming increasingly important in pediatric cardiac disorders. However, MRI normal values for atrial volumes in children are lacking. To establish pediatric reference values for atrial volumes. Retrospective. A total of 155 healthy children from two large institutions (103 male, age 13.9± 2.8 years, range 4-18 years). A 1.5 T; balanced steady-state free precession (bSSFP) sequence. The monoplane and biplane area-length methods were used to measure minimal and maximal left and right atrial volumes (LAmin , LAmax , RAmin , and RAmax ) from four-chamber (4ch) and two-chamber (2ch) MR cine images. Centile charts and tables for atrial volumes were created. Descriptive statistics, lambda-mu-sigma (LMS)-method of Cole and Green, univariable and multivariable linear regression models. A P value < 0.05 was considered to be statistically significant. In the multivariable linear model, body surface area was significantly associated with all atrial volumes and sex was significantly associated with RA volumes, LA volumes measured in the 2ch-view as well as biplane LAmax. Average atrial volumes measured: monoplane 4ch: LAmin 13.1± 4.8mL/m2 , LAmax 33.4± 8.8mL/m2 , RAmin 18.5± 6.8mL/m2 , RAmax 33.2± 9.6mL/m2 ; monoplane 2ch: LAmin 12.7± 4.9mL/m2 , LAmax 30.5± 9.5mL/m2 ; biplane: LAmin 12.3± 4.5mL/m2 , LAmax 30.9± 8.7mL/m2 . Pediatric MRI reference values for atrial volumes have been provided. 2 EVIDENCE LEVEL: 4.

FC 100: Echocardiography: A Promising Screening and Monitoring Tool for Central Venous Stenosis in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Central venous stenosis (CVS) is a common but underestimated complication of vascular access in hemodialysis (HD) patients. The objective of this study was to compare the diagnostic efficacy of echocardiography and computed tomography angiography (CTA) for CVS in HD patients with access dysfunction. METHOD This was a retrospective study. HD patients with access dysfunction admitted to our institute between 1 April 2021 and 31 October 2021 were enrolled. Echocardiography, CTA and digital subtraction angiography (DSA) were performed to assess CVS. Receiver operator characteristic analysis was performed to compare the diagnostic efficacy of echocardiographic parameters and CTA for CVS, with DSA results as the reference standard. RESULTS A total of 167 HD patients (70 males, age 63 ± 13 years) were enrolled, among whom 99 (59%) were diagnosed with CVS based on DSA and only 9 presented with significant clinical symptoms of CVS. Among all of the echocardiographic parameters, superior vena cava (SVC) diameter showed the highest efficacy for CVS diagnosis (cut-off value ≤12 mm, specificity 70%, sensitivity 77%), which was equivalent to CTA (AUC 0.79 versus 0.81; P = 0.646) (Figure 1A). Some of the other echocardiographic parameters, including maximal and minimal right atrial volume (RAV), also showed moderated diagnostic efficacy for CVS. The specificity and sensitivity increased when echocardiography and CTA were used to diagnose brachiocephalic vein and SVC stenosis instead of total CVS (Figure 1B). Patients with CVS had a smaller SVC diameter (9.8 ± 3.5 mm versus 13.7 ± 3.3 mm; P &amp;lt; 0.001) and a reduced right RAV [RAV max median 20 (interquartile range 15–27) mL versus 31(24–39) mL; P &amp;lt; 0.001; RAV min 8 (5–10) mL versus 14 (10–17) mL; P &amp;lt; 0.001] compared with non-CVS patients. Spearman's rank correlation showed a significant negative correlation between RAV and hemodialysis vintage. CONCLUSION With equivalent diagnostic power for CVS to CTA, echocardiography has the potential to be used as a screening and monitoring tool for CVS in HD patients with access dysfunction.

Right atrial strain and cardiovascular outcome in arrhythmogenic right ventricular cardiomyopathy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive fibro-fatty infiltration of the myocardium and associated with adverse cardiovascular (CV) events. This study aims to examine right atrial (RA) deformation in ARVC and understand its association with CV outcomes. RA strain was determined in 50 patients with definite ARVC, compared with a matched control group of 50 healthy individuals, and analysed for outcome association over a median follow-up duration of 5 years. A subgroup of 30 ARVC patients with normal RA volume (ARVC-N group) was compared with 30 matched controls (Control-N), and the outcome was analysed separately. RA reservoir, conduit, and pump strain were significantly impaired in ARVC vs. control. Similar observations were made in the N-ARVC subgroup. Reservoir strain was associated with an increased risk of atrial arrhythmia (AA) [hazard ratio (HR) 0.88, P < 0.01] and CV events (HR 0.92, P < 0.01). Conduit strain also predicted AA (HR 1.02, P < 0.01), while pump strain predicted CV events (HR 1.09, P = 0.02). Reservoir strain improved the fitness of bivariable models for the association of RV end-diastolic area index, RV fractional area change, and RV global longitudinal strain with CV events. ARVC patients display impaired RA strain even when RA volume is normal. Reservoir and pump strain are associated with an increased risk of CV events. Reservoir strain improved model fitness for the association of RVGLS and other echocardiographic parameters with CV events.

Utility of Automated Cardiac Chamber Volumetry by Nongated CT Pulmonary Angiography for Detection of Pulmonary Hypertension Using the 2018 Updated Hemodynamic Definition.

BACKGROUND. Noninvasive tests for pulmonary hypertension (PH) are needed to help select patients for diagnostic right heart catheterization (RHC). CT pulmonary angiography (CTPA) is commonly performed for suspected PH. OBJECTIVE. The purpose of this study was to assess the utility of CTPA-based cardiac chamber volumetric measurements for the diagnosis of PH in comparison with echocardiographic and conventional CTPA parameters, with the 2018 updated hemodynamic definition used as reference. METHODS. This retrospective study included 109 patients (72 women and 37 men; median age, 68 years) who underwent nongated CTPA, transthoracic echocardiography, and RHC for the workup of suspected PH between August 2013 and February 2016. Two radiologists independently used automated 3D segmentation software to determine the volumes of the right ventricle (RV), right atrium (RA), left ventricle (LV), and left atrium (LA) and also measured the axial diameters of the cardiac chambers, main pulmonary artery, and ascending aorta. Interobserver agreement was assessed, and mean values were obtained; one observer repeated volumetric measurements to assess intraobserver agreement. ROC analysis was used to assess diagnostic performance for the detection of PH. A multivariable binary logistic regression model was established. RESULTS. A total of 60 of 109 patients had PH. Intra- and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients, 0.935-0.999). In patients with PH versus those without PH, RV volume was 172.6 versus 118.1 mL, and RA volume was 130.2 versus 77.0 mL (both p < .05). Cardiac chamber measurements with the highest AUC for PH were the RV/LV volume ratio and RA volume (both 0.791). Significant predictors of PH20 (as defined using the 2018 hemodynamic definition from the Sixth World Symposium on Pulmonary Hypertension) after adjustment for age, sex, and body surface area included RV volume per 10 mL (odds ratio [OR], 1.21), RA volume per 10 mL (OR, 1.27), RV/LV volume ratio (OR, 2.91), and RA/LA volume ratio (OR, 11.22). Regression analysis yielded a predictive model for PH that contained two independent predictors: echocardiographic pulmonary arterial systolic pressure and CTPA-based RA volume; the model had an AUC of 0.898, sensitivity of 83.3%, and specificity of 85.7%. CONCLUSION. Automated cardiac chamber volumetry using nongated CTPA, particularly of the RA, provides incremental utility relative to echocardiographic and conventional CTPA parameters for diagnosis of PH. CLINICAL IMPACT. Automated volumetry of cardiac chambers based on nongated CTPA may facilitate early noninvasive detection of PH, identifying patients who warrant further evaluation by RHC.

Highlights From the Circulation Family of Journals

Highlights From the <i>Circulation</i> Family of Journals

Prevalence of Right Atrial Impairment and Association with Outcomes in Cardiac Amyloidosis

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy in which abnormally folded proteins deposit within the myocardium and the atrial walls. While left atrial dysfunction has been previously reported, the impact of CA on right atrial (RA) structure and function is unknown. We retrospectively studied 118 patients (67 immunoglobulin light chain [AL-CA], 51 transthyretin [ATTR-CA]; age, 70±12years; 57% men) who underwent transthoracic echocardiogram in sinus rhythm. Right atrial reservoir, conduit, and booster strain were quantified using speckle-tracking and compared between patients with CA and 50 healthy age-, sex-, and race-matched controls using the chi-squared or Mann-Whitney test. The relationship between RA parameters and mortality was assessed using Cox regression. Right atrial volume was significantly larger in cases with CA compared with in controls: 29 (22-37) vs 21 (15-25) mL/m2, P<.001. Right atrial reservoir (21% [14%-35%] vs 37% [34%-43%], P<.001), conduit 11% [18%-6%] vs 14% [11%-17%], P<.001), and booster (10% [17%-5%] vs 23% [20%-27%], P<.001) strains were all significantly more impaired in the CA group compared with controls. Compared with AL-CA, ATTR-CA patients had significantly larger RA volume (34 [26-44] vs 28 [20-35] mL/m2, P=.005) and significantly more impaired RA reservoir (17% [10%-30%] vs 27% [17%-37%], P=.007), conduit (8% [13%-6%] vs 13% [20%-8%], P=.031), and booster (7% [14%-4%] vs 11% [18%-6%], P=.030) strain. Among CA patients, RA reservoir (hazard ratio=0.97 per %, P=.006) and RA conduit (hazard ratio=1.05 per %, P=.004) were significantly associated with mortality, while RA volume (P=.362) and RA booster strain (P=.180) were not. In CA, abnormalities in RA size and strain are highly prevalent and associated with worse prognosis, suggesting the presence of intrinsic RA atriopathy. Right atrial strain appears to be a potentially useful marker in the diagnosis, subtype differentiation, and risk stratification of CA.

Reference values of left and right atrial volumes and phasic function based on a large sample of healthy Chinese adults: A cardiovascular magnetic resonance study

BackgroundThe left and right atrial (LA and RA) size and function are tightly linked to the morbidity and mortality of multiple cardiovascular diseases. We aimed to establish cardiovascular magnetic resonance (CMR) reference values for LA and RA volumes and phasic function based on a large sample of healthy Chinese adults. Methods408 validated healthy Chinese adults (54% men; aged 21–70 years) were included. LA and RA maximum, minimum, and pre-atrial contraction volumes (Vmax, Vmin, and Vpac); total, passive, and booster emptying fractions (EF total, EF passive, and EF booster); and total, passive, and active emptying volumes (TEV, PEV, and AEV) were measured on cine CMR. Normal reference values were calculated and were stratified by sex and age decades. ResultsMen demonstrated greater LAVmax, LAVmin, LAVpac, LAPEV, RAVmax, RAVmin, RAVpac, RATEV, and RAAEV, while women had higher LAEF total, LAEF booster, RAEF total, RAEF passive, and RAEF booster (all p < 0.05). Age was positively correlated with LAVpac and RAVpac in both sexes but was positively correlated with LAVmax, LAVmin, RAVmax, and RAVmin only in women (all p < 0.05). For both sexes, aging was associated with decreased LAEF total, LAEF passive, RAEF total, and RAEF passive, but increased LAEF booster (all p < 0.05). ConclusionWe systematically provide age- and sex-specific CMR reference values for LA and RA volumes and phasic function based on a large sample of healthy Chinese adults with a wide age range. Both age and sex are closely associated with biatrial volumes and function.

Prognostic value of three-dimensional echocardiographic assessment of tricuspid valve geometry and parameters of severity in atrial and ventricular functional tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial and ventricular functional tricuspid regurgitation (A-FTR and V-FTR) have recently emerged as different phenotypes of FTR. Given the difference in mechanisms that are postulated to be underlying these 2 entities, a different remodeling of tricuspid valve (TV) apparatus can occur and therefore also a specific quantitative approach could be deemed. Aim Aim of this study was to investigate the TV apparatus remodeling in the two different phenotypes of FTR: ventricular (V-FTR) and atrial (A-FTR) and the role of echocardiographic parameters of TV remodeling and TR severity to predict clinical outcomes. Material and methods The present retrospective study included consecutive patients with moderate to severe functional tricuspid regurgitation (FTR) referred for echocardiography in two Italian centers. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis. According to more recent guidelines, patients were considered having A-FTR if having history of long- standing atrial fibrillation, without history of pulmonary hypertension and left side heart disease. Results. A total of 180 patients were included. Despite the right atrial volume (RAV) was not different in the 2 groups, in A-FTR tethering height was significantly lower (11.7 ±4.8 mm vs 15.0 ± 5.5 in V-FTR. p &amp;lt;0.01) and the 3D-derived tricuspid annulus (TA) diameters were larger both in end-diastolic and mid-systolic phase (3D-TA-End diastolic- major axis: 45.2 ± 6.2 mm in A-FTR vs 42.8 ± 5.4 in V-FTR. p= 0.04; 3D-TA mid systolic major axis: 41,7 ± 6,4mm in A-FTR vs 37,9 ± 5,1 in V-FTR, P &amp;lt;0,01). 3D-TA-End diastolic- minor axis: 39.7 ± 6.8 vs 37.1 ± 5.2. p= 0.03). Regarding the parameters of severity of FTR. patients with V-FTR had larger vena contracta (VC). either when 2D estimated or 3D (2D-VC-average: 5.3 ± 2.8 mm in A-FTR vs 6.6 ± 3.7 in V-FTR. P= 0.02; 3D-VCA: 0.9 ± 0.4 cm2 vs 1.3 ± 1.1 cm2 p= 0.02); conversely the value of 2D-ERO and regurgitant volume estimated with 2D-PISA method did not show significant difference between the 2 groups (table 1). After a median follow-up of 24 months (IQR: 2-48) 72 patients (40%) reached the primary end-point and 64 (36%) hospitalized for HF. Different predictors of combined end point were found in the 2 groups: tenting height. 2D-VC. 3D-VCA and regurgitant fraction were prognostic correlates in V-FTR; TA dimensions as well as all the parameters of severe TR. including EROA with PISA method were related to the prognosis in A-FTR (table 2). Conclusions Prognostic role of quantitative parameters of FTR in A-FTR and V-FTR is different, thus reaffirming the difference in underlying pathogenic mechanisms and the needing for a more specific diagnostic approach and prognostic stratification in these two FTR phenotypes

Atrial and ventricular phenotypes in a cohort of patients with functional tricuspid regurgitation: clinical, echocardiographic and prognostic aspects

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial functional tricuspid regurgitation (A-FTR) has emerged as a newly recognized phenotype of functional tricuspid regurgitation (FTR), occurring in patients with atrial fibrillation and right atrial (RA) dilation but normal right ventricular (RV) size and function. Its prevalence, echocardiographic features and prognosis have not yet clarified since most evidence to date has included indiscriminately FTR patients with A-FTR and ventricular form (V-FTR). Aim Aim of this study was to investigate the differences between these two phenotypes of FTR in terms of clinical correlates, echocardiographic aspects and prognosis. Material and methods A total of 180 consecutive patients with moderate to severe FTR referred for echocardiography in two Italian centers were retrospectively enrolled. A-FTR was defined according to most recent guidelines criteria. The composite endpoint of death for any cause and heart failure (HF) hospitalization was used as primary outcome of this analysis; secondary end point was HF-hospitalization. Results. Patients with A-FTR were 30% of the population; they were older than those one with V-FTR; with higher systolic blood pressure and less advanced symptoms (table 1). Chronic obstructive pulmonary disease was more prevalent in V-FTR. Patients with V-FTR had larger 3D-derived right ventricle (RV) volumes, both diastolic and systolic, while right ventricle ejection fraction (RVEF) was similar. RV functional parameters as TAPSE, RVFWLS, RVGLS were significantly lower in the V-FTR patients as well as all the parameters of RV-pulmonary arterial (PA) coupling. After a median follow-up of 24 months (IQR: 2-48), 72 patients (40%) reached the primary end-point and 64 (36%) hospitalized for HF. The rate of composite end point tended to be lower in A-FTR than in V-FTR ( 29% vs 44%, p value: 0,1); the rate of hospitalization for HF was higher in V-FTR patients (22% vs 41%, p value: 0,04) (Kaplan Meier shown in figure1). Correlates of combined end point in both groups were: functional class of dyspnea (NYHA class III-IV vs I-II), severe TR grade (HR in V-FTR: 2,88 [1.63-5.06], P &amp;lt;0,01; HR in A-FTR: 8[3-17], P &amp;lt;0.01); RV volumes, RA volumes (table 2). Estimated SPAP as well as all the parameters of RV function and of RV-PA coupling were correlates of prognosis only in V-FTR; conversely, parameters of TA dimensions were related to combined end point in A-FTR phenotype, while RV function and RV-PA coupling indexes did not. Conclusions Patients having A-FTR have an incidence of combined end point slightly different, without reaching a statistically significant difference, thus remarking the fact that A-FTR could not be considered "more benign" and should therefore be targeted. Prognostic predictors are different between A-.FTR and V-FTR patients. Abstract Figure.

Effect of interventional edge-to-edge repair in tricuspid regurgitation on dimensions of the annulus

Abstract Funding Acknowledgements Type of funding sources: None. Background The technique of percutaneous tricuspid valve edge-to-edge repair (pTVR) depends upon the connection of leaflets in the area of regurgitation using a coaptation device. By closing the coaptation device a considerable tractive force is applied on the leaflets, which might have an effect on the valve annulus. The aim of this study was to examine the impact of device implantation on tricuspid annular dimensions. Methods During pTVR, 3D zoom loops of the tricuspid valve (TV) were acquired before and after clip placement using transesophageal echocardiography. Measurements of TV annular dimensions included the following parameters: annulus area (TV area), maximal diameter, minimal diameter, and eccentricity index (Figure 1). Tenting area was derived from a four-chamber view of the valve. Tricuspid regurgitation (TR) severity was graded from 1+ to 5+ by measuring vena contracta area (VCA3D) in 3D full volume color Doppler loop using multiplanar reconstruction. Right atrial (RA) and ventricular volumes (RVVd3D, RVVs3D) and function (RVEF3D) were assessed in a 3D full volume loop. Results The study population consisted of 97 patients (age 78 ± 6 years, 47 male), undergoing pTVR at our hospital. As expected, cavity dimension correlated with TV area size (for RVVd3D r = 0.51, p &amp;lt; 0.001 and for RA volume r = 0.71, p &amp;lt; 0.001). The mean TV annular area was significantly reduced (Annular area 8.53 ± 2.23 cm²/m²BSA vs. 7.55 ± 2.18 cm²/m²BSA, p &amp;lt; 0.001) and the shape of the annulus became more oval (Eccentricity index 1.2 ± 0.15 vs. 1.29 ± 0.17, p &amp;lt; 0.001) after pTVR. The reduction in annular area (12 ± 7%, range 0.7-28%) was only modestly correlated with the number of implanted coaptation devices (r = 0.30, p &amp;lt; 0.001) and the percentage reduction of VCA3D (r =0.36, p &amp;lt; 0.001). In the patient group with an annular area change ≥12%, a decrease in TR grade to ≤2+ by pTVR was achieved in 83% of cases, whereas only 62% of patients achieved moderate TR when the change in area was below 12%. Conclusion pTVR using coaptation devices reduces the area of the TV annulus. This effect may be modestly correlated to the number of devices implanted. Abstract Figure.

Correlation Between Right Atrial Function and Invasively-Measured Pulmonary Pressures in Patients with Pulmonary Arterial Hypertension

Right atrial (RA) enlargement is a measure of right ventricular (RV) overload and a prognostic marker of poorer outcomes in patients with pulmonary arterial hypertension (PAH). There are emerging reports suggesting that RA function may have predictive value in this population, however correlation with pulmonary pressures measured via invasive right heart catheterisation has not been well characterised. We sought to assess the correlation between RA strain (RAs), a novel echocardiographic measure of RA function, and invasively-derived pulmonary arterial pressures (PAP). Patients with Type-1 PAH referred to our institutional pulmonary hypertension clinics between Jan-2017 and Dec-2020 were evaluated. Patients who underwent transthoracic echocardiography within 4-weeks of right heart catheterisation were included. RAs was measured with vendor-independent software (TomTec Image Arena). Our cohort consisted of 43 patients (58.4±20.3 yrs, 70% female). All patients had normal left ventricular systolic function and the mean BMI was 28.6±7.7. 54% of patients had a dilated RV and 87% had impaired RV function by RV free wall strain. 39% of patients had increased indexed RA volumes. The mean RAs was 22.3±8.5%. RAs demonstrated a moderate positive correlation with RA emptying fraction (r = 0.511, p<0.05) and a moderate inverse correlation with RA minimum volume (r = -0.53, p<0.05) and invasively derived RA pressures (r = -0.58, p<0.05). There was no significant correlation between RAs and parameters of RV size and function, but RAs interestingly showed a strong inverse correlation with invasively derived mean PAP (r = -0.81, p<0.01). RAs had a close correlation with invasively measured mean PAP. Further studies are required to further examine this relationship.

Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia.

BACKGROUNDFew studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD.METHODSWe retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated.RESULTSIn infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e′ and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e′ and maximum RA volume index were not.CONCLUSIONSEvaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.