title: Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension.
abstract: We tested the hypothesis that the addition of right atrial (RA) remodeling to right ventricular (RV) function enhances the capability of the latter to predict long-term outcome for pulmonary hypertension (PH) patients. We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free ≤19.4 % and RA area of >18 cm(2), respectively. Long-term unfavorable outcome events were tracked for 2.0 years. RA area correlated with mean RA pressure (r = 0.62, p < 0.001), as well as with tricuspid E/E' (r = 0.38, p = 0.001). Moreover, RA area in patients with RV restrictive filling was significantly larger than that in patients with others (all p < 0.05). Kaplan-Meier analysis revealed that patients with RV-free ≤19.4 % had worse long-term outcomes than those with RV-free >19.4 % (log-rank p = 0.01), as did patients with RA area >18 cm(2) compared with those with RA area ≤18 cm(2) (log-rank p < 0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 = 3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 = 9.24; p < 0.05), and RV-free (χ2 = 17.11; p = 0.005), and further improved by addition of RA area (χ2 = 21.36, p < 0.05). In conclusion, the combined assessment of RV function and RA area results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Motoji
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.forename: Takuma
authors.initials: T
authors.lastname: Sawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Imanishi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Noriaki
authors.initials: N
authors.lastname: Emoto
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D016280:Atrial Function, Right; D062185:Atrial Pressure; D064752:Atrial Remodeling; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right