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Right atrial function and prognosis in pulmonary arterial hypertension
Authors : M D'alto (Naples,IT), A D'andrea (Naples,IT), G Di Salvo (London,GB), G Scognamiglio (Naples,IT), P Argiento (Naples,IT), E Romeo (Naples,IT), GM Di Marco (Naples,IT), A Mattera Iacono (Naples,IT), B Sarubbi (Naples,IT), MG Russo (Naples,IT)
M. D'Alto1
,
A. D'Andrea1
,
G. Di Salvo2
,
G. Scognamiglio1
,
P. Argiento1
,
E. Romeo1
,
G.M. Di Marco1
,
A. Mattera Iacono1
,
B. Sarubbi1
,
M.G. Russo1
,
1Second University of Naples - Monaldi Hospital, Department of Cardiology - Naples - Italy
,
2Royal Brompton Hospital, Paediatric Cardiology - London - United Kingdom
,
Aims: To determine whether right atrial (RA) function has prognostic value in patients with pulmonary arterial hypertension (PAH).
Methods and results: Overall, 118 patients (79 female, mean age 58±13 years) with PAH underwent standard Doppler echocardiography and strain and strain rate (SR) analysis before right heart catheterization. At a mean follow-up of 19±4 months, 34 patients (29%) had clinical worsening. On Cox's multivariable proportional-hazards regression analysis, RA reservoir function (hazard ratio [HR] 0.5; P<0.0001), RA area (HR 1.2; P<0.01), right ventricular (RV) SR (HR 0.6; P<0.0001), cardiac index (HR 0.79; P<0.01), and PaO2 (HR 0.82; P<0.01) were found to be independent correlates of cardiac events. A RA reservoir cut-off value of <1.2 ms and a RV SR cut-off value of <1% well identified patients at higher risk of clinical worsening (85.5% sensitivity; 90.4% specificity; test accuracy: 88.8%). In particular, event rates and mean survival time free of clinical worsening were: 6.1% and 23.5±2.2 months in patients with normal RA and RV strain; 45% and 20.9±5.5 months in patients with impaired RA strain and normal RV SR; 56.2% and 17.7±6.6 months in patients with normal RV SR and impaired RA strain; and 87.5% and 12.9±7.6 months in patients with impairment of both RA strain and RV SR.
Conclusion: Our data suggest that RA function has prognostic value in PAH, where a poorer RA function, as explored by strain and SR analysis, is associated with a worse outcome.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
