Cioffi Giovanni, de Simone Giovanni, Mureddu Gianfrancesco, Tarantini Luigi, Stefenelli Carlo
Department of Cardiology, Echocardiography Laboratory, Villa Bianca Hospital, via Piave 78, 38100 Trento, Italy.
Eur J Echocardiogr. 2007 Oct;8(5):322-31. doi: 10.1016/j.euje.2006.06.006. Epub 2006 Jul 28.
Pulmonary hypertension (PH) determines various adaptive changes in right ventricular (RV) geometry which may progressively lead to hypertrophy, mechanical dysfunction and dilatation with pump failure. Right atrium (RA) is theoretically involved in this physiopathological process, but its role has never been investigated. We hypothesized that RA increases volume and function to assist RV during the chronic pressure overload exposition due to PH.
We prospectively enrolled 66 consecutive patients referred to our echolab with a diagnosis of PH [defined as pulmonary artery systolic pressure (PASP) >30 mmHg] associated with disorders of the respiratory system and/or hypoxemia and normal RV systolic function. Ejection force was taken up as index of RA systolic function and calculated according to the Manning's formula. Thirty-three healthy subjects for whom PH was definitely excluded by echoDoppler evaluation were used as controls.
PASP was 42+/-10 and 20+/-8 mmHg in PH patients and controls, respectively; p=0.00001). In comparison with controls, PH patients exhibited higher RA volume (37+/-13 vs 32+/-13 ml, p=0.04) and RA ejection force (6.7+/-3.0 vs 3.5+/-1.8 Kdynes, p=0.00001). Both variables were positively related to PASP (r=0.23 and 0.48, p=0.02 and 0.00001, respectively).
In patients with chronic PH, RA size and systolic function significantly increase and parallel signs of activation of the Frank-Starling mechanism in both right chambers. The magnitude of these phenomena is positively related to PASP levels.
肺动脉高压（PH）会引发右心室（RV）几何结构的多种适应性变化，这些变化可能会逐渐导致肥厚、机械功能障碍以及伴有泵衰竭的扩张。理论上，右心房（RA）参与了这一病理生理过程，但其作用从未被研究过。我们假设，在因PH导致的慢性压力超负荷情况下，RA会增加容量和功能以辅助RV。
我们前瞻性地纳入了66例连续转诊至我们超声心动图实验室的患者，这些患者被诊断为PH（定义为肺动脉收缩压（PASP）>30 mmHg），伴有呼吸系统疾病和/或低氧血症且右心室收缩功能正常。将射血力作为RA收缩功能的指标，并根据曼宁公式进行计算。33名经超声多普勒评估明确排除PH的健康受试者作为对照。
PH患者和对照组的PASP分别为42±10 mmHg和20±8 mmHg；p = 0.00001）。与对照组相比，PH患者的RA容积更高（37±13 vs 32±13 ml，p = 0.04），RA射血力更高（6.7±3.0 vs 3.5±1.8 Kdynes，p = 0.00001）。这两个变量均与PASP呈正相关（r分别为0.23和0.48，p分别为0.02和0.00001）。
在慢性PH患者中，RA大小和收缩功能显著增加，且与两个右心室中Frank-Starling机制激活的体征平行。这些现象的程度与PASP水平呈正相关。
