Right atrial strain is predictive of clinical outcomes and invasive hemodynamic data in group 1 pulmonary arterial hypertension.
Transthoracic echocardiography (TTE) is a practical and widely used tool for risk stratification in pulmonary arterial hypertension (PAH). We hypothesized that right atrial (RA) reservoir function, represented by peak RA systolic strain, correlates with invasive hemodynamic measurements and clinical outcomes in PAH. Patients with group 1 PAH who had TTE within 6 months of index PAH clinic visit and right heart catheterization were included in this retrospective study. Peak RA strain in the 2D apical 4-chamber view was measured with speckle-tracking software. The primary endpoint was a composite of prostacyclin initiation, lung transplantation, and death. RA strain was also measured in healthy control subjects. Among the 37 patients studied, 25 (68%) met the primary endpoint. RA strain was significantly lower among patients who met the primary endpoint than among those who did not (mean 20% vs. 33%, P = 0.002). Strain was lower in PAH patients than in controls (mean 24% vs. 35%, P = 0.0001). RA strain correlated negatively with hemodynamic data including RA pressure (R = -0.31), mean pulmonary arterial pressure (R = -0.33), and pulmonary vascular resistance (R = -0.39), and positively with cardiac index (R = 0.44). In receiver operating characteristic analysis to distinguish between patients meeting the primary endpoint and event-free survivors, RA strain was not significantly different from RA volume, right ventricular (RV) fractional area change, RV basal diameter, or right ventricular systolic pressure (area under the curve 0.82, 0.81, 0.83, 0.86, and 0.97, respectively). Our results demonstrate that RA strain is predictive of clinical outcomes in PAH. Further research is needed to determine if RA strain is independently associated with outcomes in this population.
Departments of Internal Medicine and Radiology, Division of Cardiovascular Medicine, University of Michigan Health System, 1500 E. Medical Center Dr., SPC 5853, Ann Arbor, MI, 48109-5853, USA. nbhave@umich.edu.
Nicole M
NM
Bhave
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA.
Scott H
SH
Visovatti
University of Cincinnati College of Medicine, Cincinnati, USA.
Brian
B
Kulick
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA.
Theodore J
TJ
Kolias
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA.
Vallerie V
VV
McLaughlin
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019540:Area Under Curve; D062186:Arterial Pressure; D016280:Atrial Function, Right; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization; D004452:Echocardiography; D011464:Epoprostenol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical
D000959:Antihypertensive Agents; D011464:Epoprostenol
Echocardiography; Pulmonary hypertension; Right atrium; Speckle tracking; Strain