title: Right atrial volume and reservoir function are novel independent predictors of clinical worsening in patients with pulmonary hypertension.
abstract: BACKGROUND
  Symptoms and signs and indices of right heart function are predictors of clinical outcomes in patients with pulmonary hypertension (PH). However, the significance of right atrial (RA) indices has not been sufficiently investigated. We investigated whether RA parameters predict outcomes in patients with pre-capillary PH.
  
  
  METHODS
  Study subjects were 68 patients with pre-capillary PH. RA size and function (systolic, reservoir, and conduit functions) were evaluated by cardiac magnetic resonance imaging.
  
  
  RESULTS
  During the mean follow-up period of 24 months, 16 of 68 patients experienced clinical worsening (CW), defined as hospitalization because of right heart failure, lung transplantation, or PH-related death. Kaplan-Meier and log-rank test showed that World Health Organization functional class, pericardial effusion, increased brain natriuretic peptide concentration, reduced right ventricular ejection fraction (RVEF), increased minimum RA volume index, and decreased RA reservoir volume were associated with CW-free survival. The combination of RVEF and RA reservoir function was a better predictor of CW-free survival. In univariate Cox hazard proportional analysis, CW was associated with the RA reservoir volume index (hazard ratio [HR] = 0.80). In multivariate analysis, CW was associated with World Health Organization functional class (HR = 4.3), RA minimum volume index (HR = 1.07), and RA reservoir volume index (HR = 0.73).
  
  
  CONCLUSIONS
  RA volume and reservoir function and their combined use with RVEF are novel predictors of CW in patients with pre-capillary PH.
authors: First Department of Medicine.
authors: Takahiro
authors: T
authors: Sato
authors: First Department of Medicine. Electronic address: itsujino@med.hokudai.ac.jp.
authors: Ichizo
authors: I
authors: Tsujino
authors: First Department of Medicine.
authors: Hiroshi
authors: H
authors: Ohira
authors: Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital.
authors: Noriko
authors: N
authors: Oyama-Manabe
authors: Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yoichi M
authors: YM
authors: Ito
authors: First Department of Medicine.
authors: Asuka
authors: A
authors: Yamada
authors: First Department of Medicine.
authors: Daisuke
authors: D
authors: Ikeda
authors: First Department of Medicine.
authors: Taku
authors: T
authors: Watanabe
authors: First Department of Medicine.
authors: Masaharu
authors: M
authors: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D002306:Cardiac Volume / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology*; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: chronic thromboembolic pulmonary hypertension; magnetic resonance imaging; pulmonary arterial hypertension; right atrium