Meng Xiangli, Li Yidan, Li Hong, Lv Xiuzhang
Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
Echocardiography. 2018 Feb;35(2):153-161. doi: 10.1111/echo.13761. Epub 2017 Nov 26.
Pulmonary hypertension (PH) impairs right ventricular (RV) systolic and diastolic function, which in turn induces compensatory changes in right atrial (RA) function; the diverse effects on RA function are subject to much debate. We hypothesized that RA function plays a more important role in compensating RV dysfunction, than mere prevention of clinical failure in patients with PH.
We studied 54 patients with PH and 23 healthy controls. RA volume, including maximum RA volume, minimum RA volume, and the volume before atrial systole, was evaluated by 3DE. RA maximum volume index (V I), total emptying volume index (TotEVI), passive emptying volume index (PassEVI), and active ejection fraction (ActEF) were calculated. Receiver operating characteristic curve analysis was used to determine the sensitivity and specificity of various cutoff levels of the variables measured for predicting World Health Organization functional class (WHO-FC) IV in patients with PH.
RAV I in patients with PH was higher than that in controls. In patients with PH, the TotEVI was significantly higher, while PassEVI was significantly lower as compared to that in controls. ActEF was increased in patients with WHO functional class (WHO-FC) III PH as compared to that in controls (P = .003) but was reduced in more advanced cases (WHO-FC IV). In addition, the area under the curve of 3D RA ActEF was larger than those of 2D RA ActEF, RA GLS, RA area, FAC, TAPSE, and RIMP (P < .01 for all) for predicting WHO-FC IV.
We demonstrated that RA function plays a more important role in compensating RV dysfunction then mere prevention of clinical failure in PH.
肺动脉高压（PH）会损害右心室（RV）的收缩和舒张功能，进而引起右心房（RA）功能的代偿性变化；然而，对RA功能的多种影响仍存在诸多争议。我们假设，与单纯预防PH患者的临床失代偿相比，RA功能在代偿RV功能障碍中发挥着更重要的作用。
我们研究了54例PH患者和23名健康对照者。通过三维超声心动图（3DE）评估RA容积，包括RA最大容积、最小容积和心房收缩前容积。计算RA最大容积指数（VI）、总排空容积指数（TotEVI）、被动排空容积指数（PassEVI）和主动射血分数（ActEF）。采用受试者工作特征曲线分析来确定所测变量不同临界值对预测世界卫生组织功能分级（WHO-FC）IV级PH患者的敏感性和特异性。
PH患者的RA VI高于对照组。与对照组相比，PH患者的TotEVI显著升高，而PassEVI显著降低。与对照组相比，WHO功能分级（WHO-FC）III级PH患者的ActEF升高（P = 0.003），但在病情更严重的患者（WHO-FC IV级）中ActEF降低。此外，在预测WHO-FC IV级时，三维RA ActEF的曲线下面积大于二维RA ActEF、RA纵向应变（RA GLS）、RA面积、面积变化分数（FAC）、三尖瓣环平面收缩期位移（TAPSE）和右心室心肌做功指数（RIMP）（所有P < 0.01）。
我们证明，与单纯预防PH患者的临床失代偿相比，RA功能在代偿RV功能障碍中发挥着更重要的作用。
