title: Right atrium contractility and right ventricular diastolic function assessed by pulsed tissue Doppler imaging can predict brain natriuretic peptide in adults with acquired pulmonary hypertension.
abstract: OBJECTIVE
  We evaluated right atrial (RA) contractility and right ventricular (RV) diastolic function in adult patients with acquired chronic pulmonary hypertension (PH) by pulsed Tissue Doppler Imaging (TDI) and assessed their relationship with serum brain natriuretic peptide (BNP).
  
  
  METHODS
  Systolic myocardial wave (Sa), early diastolic myocardial wave (Ea), and late diastolic myocardial wave (Aa) at the tricuspid annulus were recorded in 77 consecutive patients with acquired PH. Early (E) RV inflow waves were recorded from 4-chamber views. RV Aa was regarded as the parameter of RA contractility and RV E/Ea was taken as the parameter of RV diastolic function using TDI.
  
  
  RESULTS
  All subjects had elevated BNP (mean 188.9 +/- 244.0 pg/dl) and pulmonary arterial systolic pressure (PASP) estimated at 62.9 +/- 26.7 mm Hg. BNP levels were positively correlated with RV E/Ea, Aa and PASP (r = 0.47, p < 0.0001 and r = 0.35, p < 0.01, respectively) but negatively with Aa (r = -0.29, p < 0.05). Next, all predictor variables were used in a multiple regression model with serum BNP values as dependent variables, refined to include 3 predictors: RV E/Ea, Aa, and PASP, which were all found to influence serum BNP values (p < 0.0001) by the formula Y = 34.1X1**-19.11X2**+2.95X3* (**p < 0.001, *p < 0.01) where Y = BNP, X1 = E/Ea of RV, X2 = Aa, and X3 = PASP (standard regression coefficients were 0.37, -0.34 and 0.34, respectively).
  
  
  CONCLUSIONS
  Serum BNP correlates with RA contractility and RV diastolic dysfunction by RV TDI in adults with acquired PH. Increased BNP may be related to decreased RA systolic function and RV diastolic function in these patients.
authors.affiliation: Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Shiina
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.forename: Kwangho
authors.initials: K
authors.lastname: Lee
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: Tai
authors.initials: T
authors.lastname: Sekine
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kawakubo
authors.forename: Maiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Rei
authors.initials: R
authors.lastname: Yajima
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kuriyama
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000328:Adult; D000368:Aged; D016280:Atrial Function, Right / Q000502:physiology*; D015415:Biomarkers / Q000097:blood; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D013599:Systole / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain