Brunner Nathan W, Haddad Francois, Kobayashi Yukari, Hsi Andrew, Swiston John R, Gin Kenneth G, Zamanian Roham T
Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, California, USA ; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
Pulm Circ. 2015 Sep;5(3):473-80. doi: 10.1086/682218.
Although left atrial function has been extensively studied in patients with heart failure, the determinants and clinical correlates of impaired right atrial (RA) function have been poorly studied. We investigated measures of RA function in pulmonary arterial hypertension (PAH). We identified all treatment-naive patients with World Health Organization category 1 PAH seen at our center during 2000-2011 who had right heart catheterization and 6-minute walk test (6MWT) within 1 month of initial echocardiographic examination. Atrial size was measured using the monoplane area-length method, and atrial function was quantified using total, passive, and active RA emptying fractions (RAEFs). We compared measures of RAEF with known prognostic clinical, echocardiographic, and hemodynamic parameters. For the subset of patients with follow-up echocardiographic examination/6MWT within 6-18 months, we investigated the change in RAEF. In an exploratory analysis, we investigated the association between RAEF and mortality. Our population consisted of 39 patients with treatment-naive (incident) PAH, 30 of whom had follow-up testing. The mean total, passive, and active RAEFs were 24.4% ± 15.1%, 8.5% ± 6.9%, and 17.6% ± 13.9%, respectively. Total and active RAEFs correlated with tricuspid annular plane systolic excursion (P = 0.004 and P = 0.005) and cardiac output (P = 0.02 and P = 0.01). The change in active RAEF correlated with change in 6-minute walk distance (P = 0.02). In our Cox regression analysis, low active and total RAEF were associated with mortality, with hazard ratios of 5.6 (95% confidence interval [CI], 1.2-26.2; P = 0.03) and 4.2 (95% CI, 1.1-15.5; P = 0.03), respectively. Passive RAEF was poorly reproducible and not associated with outcome. Measures of RAEF appear to have prognostic importance in PAH and warrant further study.
尽管心力衰竭患者的左心房功能已得到广泛研究，但右心房（RA）功能受损的决定因素及临床关联却鲜有研究。我们对肺动脉高压（PAH）患者的RA功能指标进行了调查。我们确定了2000年至2011年期间在我们中心就诊的所有未经治疗的世界卫生组织1类PAH患者，这些患者在首次超声心动图检查后1个月内进行了右心导管检查和6分钟步行试验（6MWT）。使用单平面面积长度法测量心房大小，并使用总、被动和主动RA排空分数（RAEFs）对心房功能进行量化。我们将RAEF指标与已知的预后临床、超声心动图和血流动力学参数进行了比较。对于在6至18个月内进行了随访超声心动图检查/6MWT的患者子集，我们调查了RAEF的变化。在一项探索性分析中，我们研究了RAEF与死亡率之间的关联。我们的研究对象包括39例未经治疗（初发）的PAH患者，其中30例进行了随访检测。总、被动和主动RAEF的平均值分别为24.4%±15.1%、8.5%±6.9%和17.6%±13.9%。总RAEF和主动RAEF与三尖瓣环平面收缩期位移（P = 0.004和P = 0.005）及心输出量（P = 0.02和P = 0.01）相关。主动RAEF的变化与6分钟步行距离的变化相关（P = 0.02）。在我们的Cox回归分析中，低主动RAEF和总RAEF与死亡率相关，危险比分别为5.6（95%置信区间[CI]，1.2 - 26.2；P = 0.03）和4.2（95%CI，1.1 - 15.5；P = 0.03）。被动RAEF的可重复性差，且与预后无关。RAEF指标在PAH中似乎具有预后重要性，值得进一步研究。
