Right Atrium’s Pump And Reservoir Functions are Preserved But Conduit Function Impaired in Patients with Secondary Pulmonary Hypertension with Different Etiologies and Severities

Abstract

Objective: Pulmonary hypertension (PHT) may result in right heart failure and death. Changes in right atrial function and size have been poorly studied in PHT. We aimed to determine how right atrial functions and size are affected in patients with secondary PHT with different severities and etiologies. Materials and Method: This study enrolled a total of 83 subjects with PHT secondary to left heart diseases excluding left ventricular systolic dysfunction, connective tissue disorders, and chronic respiratory diseases, and 49 healthy age- and sex-matched healthy controls. All subjects underwent 2- dimensional echocardiography and strain rate measurement to quantify right atrial size and function. Subjects with PHT were compared with the controls and with each other. Results: Subjects with PHT had significantly larger right atrial diameters and a significantly lower right atrial ejection fraction compared to controls. Although right atrial ejection fraction worsened in moderate and severe PHT, right atrial lateral wall late diastolic strain rate was preserved in different PHT severities. With increasing PHT severity, there occurred an increase in the right atrium’s reservoir/conduit ratio where right atrial emptying worsened but right atrial filling was preserved. The three PHT etiologies were comparable with respect to right atrial size and function. Conclusion: Our findings suggest that right atrium preserves its systolic function and behaves like more of a reservoir than a conduit in PHT. These changes together may help to increase right ventricular preload to sustain pulmonary and systemic output. PHT etiologies do not appear to exert any differential effect on right atrial function and size in PHT

Keywords

• Pulmonary hypertension
• right atrium
• echocardiography
• strain rate

Değișik Etiyolojilere Bağlı ve Değișen Ciddiyetteki İkincil Pulmoner Hipertansiyonda Sağ Atriyumun Pompalama ve Depolama Fonksiyonları Korunmakta Ancak İletim Fonksiyonu Bozulmaktadır

Abstract

Amaç: Pulmoner hipertansiyon (PHT) sağ ventrikül yetersizliği ve ölüme yol açabilen bir hastalıktır. PHT’de sağ atriyal fonksiyon ve boyutlardaki değișim hakkında az çalıșma vardır. Biz bu çalıșmada, değișik ciddiyet ve etiyolojilere bağlı sekonder PHT’de sağ atriyal fonksiyon ve boyutların nasıl değiștiğini belirlemeyi amaçladık. Gereç ve Yöntem: Bu çalıșmaya, sol ventrikül sistolik disfonksiyonu olmayan sol kalp hastalıkları, bağ dokusu hastalıkları ve kronik respiratuar hastalıklara sekonder 83 PHT hastası ve 49 yașa ve cinsiyete göre eșleștirilmiș sağlıklı kontrol alındı. Tüm deneklerde 2 boyutlu ekokardiyografi ve strain hızı ölçümü ile sağ atriyal depolama, iletim ve pompa fonksiyonları ve 2 boyutlu ekokardiyografik boyutlar değerlendirildi. PHT olan hastalar kontrol grubu ile ve kendi içlerinde karșılaștırıldı. Bulgular: PHT olan hastalarda kontrol grubuna oranla anlamlı șekilde sağ atriyal çaplar daha büyük ve sağ atriyal ejeksiyon fraksiyonu daha düșüktü. Orta ve ciddi PHT’de sağ atriyal ejeksiyon fraksiyonu kötüleșse de, sağ atriyal lateral duvar geç diastolik (atriyal sistolik) strain hızı farklı PHT ciddiyetlerinde korunmuș olarak bulundu. Artan PHT ciddiyeti ile birlikte, sağ atriyumun boșalma kabiliyetinin azaldığı ancak dolumunun sağlam kaldığı depolama/iletme oranında artıș tespit edildi. Üç PHT etiyolojisinin sağ atriyal boyut ve fonksiyon yönünden farklılık göstermedikleri görüldü. Sonuç: Sonuçlarımız göstermektedir ki, sekonder PHT’de sağ atriyum sistolik fonksiyonu korunmakta ve sağ atriyum kanı ileten bir boșluktan daha çok depolayan bir boșluk haline gelmektedir. Bu değișiklikler hep birlikte sağ ventrikül önyükünün korunması ve böylece pulmoner ve sistemik debinin devam ettirilmesine yardım ediyor olabilirler. PHT etiyolojileri sağ atriyal fonksiyon ve boyutlarına etki etmiyor görünmektedir.

Keywords

• Pulmoner hipertansiyon
• sağ atriyum
• ekokardiyografi
• strain hızı

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