Right atrial function in patients with pulmonary hypertension: A study with two-dimensional speckle-tracking echocardiography

Background: The role of right atrial (RA) dysfunction in patients with pulmonary hypertension (PH), as evaluated by two-dimensional speckle-tracking echocardiography (2D-STE) remains to be determined. Methods: Sixty consecutive PH patients and 30 healthy volunteers were included. RA function was evaluated by 2D-STE, and the following parameters were recorded: an average longitudinal strain (LS) curve that included LSpos during RA filling and LSneg representing RA active contraction (their summation is LStot), the phasic RA volumes, total RA emptying fraction, and the ratio of RA passive and active emptying to total emptying. The associations between these indices and the results of invasive pulmonary hemodynamics, cardiac structure and function, and NT-terminal pro brain natriuretic peptide (NT-proBNP) level were evaluated. Results: LStot, total RA emptying fraction, LSpos, passive RA emptying fraction were significantly lower, while the contribution of active RA empting fraction/total RA emptying fraction was higher in PH patients than in controls. Among PH patients, LStot was negatively correlated with greater RA size, RA pressure, and pulmonary vascular resistance, but not pulmonary artery pressure, while LStot was also negatively associated with right ventricular enlargement and higher NT-proBNP. In receiver-operator characteristic analysis, RA LStot was of optimal accuracy for prediction of WHO-function class >= III in PH patients. Conclusions: PH was associated with impaired reservoir and conduit function, but enhanced active contract function of RA, while RA LStot confers an optimal predictive effect of poor WHO-function class in PH patients. (C) 2017 Elsevier B.V. All rights reserved.