Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College NHS Trust, Du Cane Road, London W12 0HS, UK.
Eur Heart J Cardiovasc Imaging. 2012 Aug;13(8):666-72. doi: 10.1093/ehjci/jes003. Epub 2012 Jan 30.
Right atrial (RA) dilatation may be important for patients' outcome in pulmonary arterial hypertension (PAH). The aim of this study was to examine the longitudinal RA and right ventricular (RV) remodelling in PAH patients using real-time three-dimensional echocardiography (3DE) and their relation to clinical outcome.
Sixty-two consecutive PAH patients were studied and compared with a control group of 30 healthy volunteers. RA and RV sphericity indices were measured with 3DE. RV ejection fraction (RVEF), RA volume (RAvol), and the quantification of jet area of tricuspid regurgitation (TR) were measured. Two observers were used for reproducibility assessment. The geometrical change of RA and RV was assessed in relation to clinical outcome, as defined by the increase of functional class or admission to the hospital due to right heart failure. Over 1 year of follow-up, there was significant increase of RA sphericity index (0.85±0.16 vs. 1.2±0.24, P<0.01), RV dilatation (RV sphericity index 0.71±0.07 vs. 0.98±0.04, P<0.01), as well as deterioration of RV systolic function (RVEF 33±8.2 vs. 28±7.6%, P<0.01). Twenty-three patients (37%) had a clinical deterioration within 1 year. An increase of RA sphericity index>0.24 predicted clinical deterioration with a sensitivity of 96% and a specificity of 90% [area under the curve (AUC) 0.97]. RV sphericity index was less sensitive (70%) and specific (62%) in predicting clinical deterioration (AUC 0.649). The deterioration in RVEF had a sensitivity of 91.1% and a specificity of 35.3% (AUC 0.479) in predicting clinical deterioration. The dilatation of RA>14 mL over 1 year had high sensitivity at 82.6% but low specificity at 30.8% in predicting clinical deterioration.
PAH leads to RA and RV dilatation and functional deterioration which are linked to an adverse clinical outcome. 3DE measurement of RA sphericity index may be a suitable index in predicting clinical deterioration of PAH patients.
右心房（RA）扩张可能对肺动脉高压（PAH）患者的预后很重要。本研究的目的是使用实时三维超声心动图（3DE）检查 PAH 患者的 RA 和右心室（RV）重塑的纵向变化，并探讨其与临床结果的关系。
连续研究了 62 例 PAH 患者，并与 30 名健康志愿者的对照组进行比较。使用 3DE 测量 RA 和 RV 的球形指数。测量 RV 射血分数（RVEF）、RA 容积（RAvol）和三尖瓣反流（TR）射流面积的量化。使用两名观察者进行可重复性评估。根据功能分级的增加或因右心衰竭住院的情况，评估 RA 和 RV 的几何变化与临床结果的关系。在 1 年的随访期间，RA 球形指数（0.85±0.16 与 1.2±0.24，P<0.01）、RV 扩张（RV 球形指数 0.71±0.07 与 0.98±0.04，P<0.01）均有显著增加，以及 RV 收缩功能恶化（RVEF 33±8.2 与 28±7.6%，P<0.01）。在 1 年内，23 例（37%）患者临床恶化。RA 球形指数增加>0.24 可预测临床恶化，其敏感性为 96%，特异性为 90%[曲线下面积（AUC）为 0.97]。RV 球形指数在预测临床恶化时的敏感性较低（70%），特异性（62%）较低（AUC 为 0.649）。RVEF 恶化对预测临床恶化的敏感性为 91.1%，特异性为 35.3%（AUC 为 0.479）。1 年内 RA 扩张>14ml 对预测临床恶化的敏感性为 82.6%，但特异性仅为 30.8%。
PAH 导致 RA 和 RV 扩张和功能恶化，与不良临床结局相关。3DE 测量 RA 球形指数可能是预测 PAH 患者临床恶化的合适指标。
