aDepartment of Cardiology bDivision of Internal Medicine, Hospital Maggiore della Carità, University of Piemonte Orientale, Novara, Italy.
J Cardiovasc Med (Hagerstown). 2017 Nov;18(11):866-874. doi: 10.2459/JCM.0000000000000525.
Increased right atrial size is related to adverse prognosis in pulmonary hypertension. The potential incremental value of right atrial function assessment is still unclear. We tested the relationship between right atrial two-dimensional speckle-tracking echocardiography impairment and hemodynamic, functional and clinical deterioration in patients with pulmonary hypertension.
We prospectively evaluated 36 patients (27 female, 9 male; mean age 68 ± 13 years) with suspected pulmonary hypertension undergoing right heart catheterization and 16 matched controls. All patients underwent baseline evaluation by New York Heart Association functional class, 6-min walking test, brain natriuretic peptide (BNP), and standard two-dimensional echocardiography in less than 48 h of right heart catheterization. Right atrial two-dimensional speckle-tracking echocardiography was assessed by averaging all segments in standard four-chamber apical view.
Right atrial global integral strain was significantly lower in patients compared with controls (11.40 ± 5.22% vs. 25.72 ± 5.95 P < 0.001). Moreover, right atrial global strain, but not right atrial area or volume, was correlated with invasively measured cardiac index (CI) (r = 0.72; P < 0.0001) and pulmonary vascular resistances in all patients, even though stronger in subjects with precapillary pulmonary hypertension (r = -0.42, P = 0.018; r = -0.54, P = 0.007 respectively; P = 0.007). It was also correlated with New York Heart Association (P = 0.027), BNP (P = 0.002), and 6-min walking test (P = 0.006). After multivariate analysis including right atrial volume, tricuspid annular plane systolic excursion, left atrial strain, and BNP, right atrial global strain showed the strongest correlation with CI. Area under the curve optimal cutoff for predicting CI at least 2.4 l/min/m was 17% (area under the curve: 0.83, sensitivity: 90%, specificity: 54%).
Right atrial global strain can identify right atrial functional impairment before structural changes and may be implemented in a comprehensive, noninvasive right heart assessment for diagnosis and follow-up of pulmonary hypertension patients.
右心房增大与肺动脉高压的不良预后相关。右心房功能评估的潜在增量价值尚不清楚。我们检测了肺动脉高压患者的右心房二维斑点追踪超声心动图损伤与血流动力学、功能和临床恶化之间的关系。
我们前瞻性评估了 36 名（27 名女性，9 名男性；平均年龄 68±13 岁）疑似肺动脉高压患者，这些患者在右心导管检查前 48 小时内接受了纽约心脏协会功能分级、6 分钟步行试验、脑钠肽（BNP）和标准二维超声心动图检查。右心房二维斑点追踪超声心动图通过在标准的四腔心 apical 视图中平均所有节段进行评估。
与对照组相比，患者的右心房整体积分应变明显降低（11.40±5.22%比 25.72±5.95%，P<0.001）。此外，右心房整体应变与右心房面积或容积均与所有患者的侵入性测量心指数（CI）相关（r=0.72；P<0.0001），即使在毛细血管前肺动脉高压患者中，相关性也更强（r=-0.42，P=0.018；r=-0.54，P=0.007；P=0.007）。它还与纽约心脏协会（P=0.027）、BNP（P=0.002）和 6 分钟步行试验（P=0.006）相关。包括右心房容积、三尖瓣环平面收缩期位移、左心房应变和 BNP 的多元分析后，右心房整体应变与 CI 的相关性最强。预测 CI 至少 2.4 l/min/m 的最佳截断面积曲线下面积为 17%（曲线下面积：0.83，灵敏度：90%，特异性：54%）。
右心房整体应变可在结构改变之前识别右心房功能障碍，可用于综合、无创的右心评估，用于诊断和随访肺动脉高压患者。
