title: Right atrial emptying fraction non-invasively predicts mortality in pulmonary hypertension.
abstract: Right-sided heart failure is the most common cause of death in pulmonary hypertension (PH). Echocardiographic measurements of right atrial (RA) size are associated with worse outcome in PH, however the association between RA function and death in PH has not been well-described. 160 PH patients (World Health Organization groups 1-5) underwent cardiac magnetic resonance imaging (cMRI) and right heart catheterization (RHC) within 6 weeks of each other at a tertiary care academic medical center in the United States. We measured cMRI RA maximum and minimum volumes indexed to body surface area and calculated RA emptying fraction (RAEF). We evaluated the relationship between RAEF and clinical variables with death using Cox proportional hazard models. 57 deaths occurred during a median follow-up of 3.5 years (36 % died overall, 10 % per year). RAEF was directly correlated in univariate analyses with right ventricular (RV) ejection fraction, left ventricular (LV) ejection fraction, LV size, cardiac index, absence of tricuspid and pulmonic regurgitation, absence of pericardial effusion, estimated glomerular filtration rate, 6-minute walk distance, and pulmonary arterial oxygen saturation, whereas it was inversely correlated with death, BNP, heart rate, mean RA pressure, mean PA pressure, pulmonary and systemic vascular resistance, RV size, and RA size. Using multivariate analyses, RAEF had a robust inverse association with death after adjusting for measured risk factors (HR per 5 % change in RAEF: 0.83 [95 % CI 0.73-0.94], p = 0.003). In PH patients, decreased RAEF by cMRI is independently associated with worse survival after adjustment for other risk factors.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hartford Hospital, 85 Jefferson Street, Suite 208, Hartford, CT, 06106-2602, USA.
authors.forename: Konstadina
authors.initials: K
authors.lastname: Darsaklis
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Dickson
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
authors.forename: William
authors.initials: W
authors.lastname: Cornwell
authors.affiliation: Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Torres
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Chin
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA. susan.matulevicius@utsouthwestern.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Matulevicius
mesh_terms: D000328:Adult; D000368:Aged; D016280:Atrial Function, Right; D006328:Cardiac Catheterization; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D062606:Tertiary Care Centers; D013781:Texas; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Atrium; Magnetic resonance imaging; Pulmonary heart disease; Right heart failure