Journal
PULMONARY CIRCULATION
Volume 5, Issue 3, Pages 473-480Publisher
SAGE PUBLICATIONS INC
DOI: 10.1086/682218
Keywords
pulmonary arterial hypertension; right atrial emptying fraction; echocardiography; prognosis
Funding
- Vera Moulton Wall Center (VMWC) for Pulmonary Vascular Disease at Stanford University (Stanford, California)
- VMWC
- University of British Columbia
- National Institutes of Health/National Heart, Lung, and Blood Institute
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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 treatmentnaive (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.
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