Markiewitz Nathan D, Wang Yan, Berg Robert A, Yehya Nadir, Dixon Celeste, Mercer-Rosa Laura, Himebauch Adam S
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Cardiology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA.
Crit Care Explor. 2025 Mar 18;7(3):e1230. doi: 10.1097/CCE.0000000000001230. eCollection 2025 Mar 1.
Right atrial (RA) dysfunction is associated with worse outcomes in some populations with pulmonary hypertension or respiratory failure but the prevalence and correlates of RA dysfunction in pediatric acute respiratory distress syndrome (PARDS) are unknown.
The aim of this study was to evaluate RA function by characterizing the prevalence and pattern of RA dysfunction within the first 24 hours of PARDS onset. We hypothesized that RA dysfunction would be common and correlate with the presence of pulmonary hypertension and right ventricular (RV) systolic dysfunction.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective, single-center cohort study at a tertiary care PICU of children (< 18 yr) with a clinically obtained echocardiogram within 24 hours following PARDS diagnosis and healthy controls without cardiopulmonary disease.
Echocardiograms were evaluated for conventional and speckle-tracking (or strain) echocardiographic measures of RA and RV systolic function. Nonparametric summary statistics, comparisons, and correlational analyses were completed.
Ninety-two PARDS patients and 55 controls were included. Using a priori thresholds (> 2 sds of control values), 49% (n = 45) of PARDS patients demonstrated RA dysfunction in at least one RA functional metric. The maximal RA strain during the reservoir phase was reduced in PARDS compared with controls (median 40.2% vs. 53.7%; p < 0.001). Patients with echocardiographic evidence of pulmonary hypertension had lower maximal RA strain during the reservoir phase (31.7%) compared with patients without (40.5%; p < 0.05). Patients with higher brain-type natriuretic peptide plasma concentrations had worse RA function. RA function significantly correlated with conventional and strain measures of RV systolic function.
RA dysfunction is common within the first 24 hours of PARDS onset. RA dysfunction during the reservoir phase is associated with pulmonary hypertension and RV systolic dysfunction. Future studies investigating trajectories of RA function and their association with outcomes in PARDS patients are needed.
右心房（RA）功能障碍在一些患有肺动脉高压或呼吸衰竭的人群中与更差的预后相关，但小儿急性呼吸窘迫综合征（PARDS）中RA功能障碍的患病率及其相关因素尚不清楚。
本研究的目的是通过描述PARDS发病后24小时内RA功能障碍的患病率和模式来评估RA功能。我们假设RA功能障碍很常见，并且与肺动脉高压和右心室（RV）收缩功能障碍的存在相关。
设计、背景和参与者：在一家三级护理儿科重症监护病房（PICU）进行的回顾性单中心队列研究，研究对象为PARDS诊断后24小时内接受临床超声心动图检查的18岁以下儿童，以及无心肺疾病的健康对照。
对超声心动图进行评估，以获取RA和RV收缩功能的传统及斑点追踪（或应变）超声心动图测量指标。完成了非参数汇总统计、比较和相关性分析。
纳入了92例PARDS患者和55例对照。使用先验阈值（>对照值的2个标准差），49%（n = 45）的PARDS患者在至少一项RA功能指标中表现出RA功能障碍。与对照组相比，PARDS患者在储血期的最大RA应变降低（中位数40.2%对53.7%；p < 0.001）。有超声心动图证据显示肺动脉高压患者在储血期的最大RA应变（31.7%）低于无肺动脉高压患者（40.5%；p < 0.05）。血浆脑钠肽浓度较高的患者RA功能较差。RA功能与RV收缩功能的传统及应变测量指标显著相关。
RA功能障碍在PARDS发病后的24小时内很常见。储血期的RA功能障碍与肺动脉高压和RV收缩功能障碍相关。需要进一步研究PARDS患者RA功能的变化轨迹及其与预后的关系。
