Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension.
Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSERA) and that occurring before RA contraction (TAPSERV). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSERA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects.
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Joseph A
JA
Sivak
Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Amresh
A
Raina
Division of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Paul R
PR
Forfia
echocardiography; right ventricular failure; tricuspid annular plane systolic excursion
Congest Heart Fail. 2007 Jul-Aug;13(4):200-4
17673871
Am J Respir Crit Care Med. 2006 Nov 1;174(9):1034-41
16888289
J Am Coll Cardiol. 2002 Apr 3;39(7):1214-9
11923049
Eur Heart J. 2009 Oct;30(20):2493-537
19713419
J Am Coll Cardiol. 1990 Jul;16(1):181-9
2193048
Chest. 2011 Jul;140(1):27-33
21106653
Curr Cardiol Rev. 2008 Feb;4(1):49-59
19924277
J Am Soc Echocardiogr. 2014 Jun;27(6):657-665.e3
24656881
J Am Soc Echocardiogr. 2005 Dec;18(12 ):1440-63
16376782
Int J Cardiovasc Imaging. 2008 Oct;24(7):711-2
18512128
Am J Cardiol. 2013 Jan 1;111(1):143-8
23102474
Eur Heart J Cardiovasc Imaging. 2012 Aug;13(8):666-72
22294683
Int J Cardiol. 2010 Apr 30;140(3):272-8
19070379
Int J Cardiovasc Imaging. 2014 Oct;30(7):1269-77
24879080
J Am Coll Cardiol. 2009 Apr 28;53(17):1573-619
19389575
Am Heart J. 2007 Jan;153(1):127-32
17174650
Int J Cardiol. 2013 Sep 1;167(5):2300-5
22727973
Echocardiography. 2007 Feb;24(2):118-25
17313542
J Heart Lung Transplant. 2014 Feb;33(2):123-6
24268184
Int J Cardiovasc Imaging. 2008 Oct;24(7):703-10
18454278
Am J Cardiol. 2005 Oct 15;96(8):1173-8
16214459
Circ Cardiovasc Imaging. 2013 Sep;6(5):711-21
23811750
Ann Intern Med. 1991 Sep 1;115(5):343-9
1863023
Cathet Cardiovasc Diagn. 1992 Sep;27(1):28-33; discussion 33-4
1525806