title: Importance of End-Diastolic Rather than End-Systolic Right Atrial Size in Chronic Pulmonary Hypertension.
abstract: BACKGROUND
  Right atrial (RA) enlargement has been associated with worse clinical outcomes in chronic pulmonary hypertension (cPH) patients. Even though current guidelines only recommend measurement of RA dimensions at the end of ventricular systole in these patients, there is paucity of information regarding the potential utility of RA dimensions obtained at the end of ventricular diastole.
  
  
  METHODS
  In this retrospective study, standard echocardiographic data were collected from 80 studies. The population studied was divided into Group I that consisted of 35 patients (52 ± 10 years) without PH while Group II included 45 patients (56 ± 14 years; P = 0.2) with cPH. RA measurements were obtained not only at the end of ventricular systole, but also at the end of ventricular diastole to determine which RA measurement was more indicative of abnormal right ventricular afterload.
  
  
  RESULTS
  Even though all RA measurements were abnormal, RA area (>8.4 cm(2) ) measured at the end of ventricular diastole was the most useful RA variable to identify cPH patients with elevated pulmonary pressures (P < 0.0001) and with an abnormal pulmonary vascular resistance (P = 0.001).
  
  
  CONCLUSIONS
  Based on these results, it appears that isolated RA measurements made at the end of ventricular systole are insufficient to fully explain the hemodynamic load of cPH. Additional studies are now required to determine whether sequential monitoring of the composite change in RA dimensions that occur throughout the cardiac cycle over time correlates better with response to vasodilator therapy and overall clinical outcomes.
authors.affiliation: Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
authors.forename: Angel
authors.initials: A
authors.lastname: Lopez-Candales
authors.affiliation: Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Denada S
authors.initials: DS
authors.lastname: Palm
authors.affiliation: UC Heart, Lung & Vascular Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Francisco R
authors.initials: FR
authors.lastname: Lopez
authors.affiliation: Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
authors.forename: Reynerio
authors.initials: R
authors.lastname: Perez
authors.affiliation: University of Puerto Rico, Rio Piedras, Puerto Rico.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Candales
mesh_terms: D002908:Chronic Disease; D003971:Diastole; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: chronic pulmonary hypertension; echocardiography; right atrial size; right ventricular dysfunction