title: Maximal systolic excursion of the tricuspid annulus is independent of right atrial size and function in chronic pulmonary hypertension.
abstract: BACKGROUND
  Even though the tricuspid annulus (TA) is anatomically and functionally related to right atrioventricular dependence and tricuspid annular plane systolic excursion (TAPSE) is a well-known measure of right ventricular (RV) systolic function, there is paucity of data regarding the potential impact that right atrial (RA) size and function have on TAPSE. Hence, we sought to determine whether RA volumetric and longitudinal measures affect TAPSE in patients with chronic pulmonary hypertension (cPH).
  
  
  METHODS
  In this retrospective study, echocardiographic data from 110 patients were reviewed and the studied population was divided into Group I consisting of 50 patients (50±11 years) without PH and Group II that included 60 patients (55±14 years) with cPH.
  
  
  RESULTS
  Even though RA areas, RA fractional area change, and maximal long-axis length measurements were abnormal in cPH patients, TA tissue Doppler imaging systolic velocity and RV fractional area change were the only useful variables in identifying patients with abnormal TAPSE (P<.0001 and P=.018, respectively). Additionally, TAPSE was independent of all RA measures, left ventricular ejection fraction, and age (P>.05).
  
  
  CONCLUSIONS
  Based on these results, TAPSE does not appear to be influenced by either RA size or function. Additional studies using strain echocardiography to interrogate RA mechanics might now be very useful to advance our understanding of TA motion in cPH patients given recent data showing that RA function accounts for a significantly greater proportion of total right heart function in patients with cPH than in normal subjects.
authors.affiliation: Department of Internal Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
authors.forename: Dagmar F
authors.identifier: http://orcid.org/0000-0003-1850-9078
authors.initials: DF
authors.lastname: Hernandez-Suarez
authors.affiliation: Department of Medicine and Cardiovascular Health and Disease Division, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: López Menéndez
authors.affiliation: Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
authors.forename: Angel
authors.initials: A
authors.lastname: López-Candales
mesh_terms: D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013599:Systole; D014261:Tricuspid Valve / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology*
keywords: chronic pulmonary hypertension; echocardiography; right atrium; tricuspid annular plane systolic excursion