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
References
- 1. Gaynor SL, Maniar HS, Prasad SM, et al. Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 2005;288(5):H2140-5.
- 2. Gorcsan J 3rd, Edwards TD, Ziady GM, et al. Transesophageal Echocardiography to Evaluate Patients With Severe Pulmonary Hypertension for Lung Transplantation. Ann Thorac Surg 1995 59: 717-722
- 3. Galiè N, Humbert M, Vachiery JL et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015 Oct;46(4):903-75. doi: 10.1183/ 13993003.01032-2015. Epub 2015 Aug 29.
- 4. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo. 2014.10.003.
- 5. Quiñones MA, Otto CM, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002 Feb;15(2):167-84.
- 6. Rudsky LG, Lai WW, Afilalo J, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
- 7. Telagh R, Hui W, Abd El Rahman M, et al. Assessment of Regional Atrial Function in Patients with Hypertrophic Cardiomyopathies Using Tissue Doppler Measurement. Pediatr Cardiol. 2007 Sep 21 ; [Epub ahead of print].
- 8. Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 2002;39(7):1214-9.
- 9. Leeuwenburgh BP, Steendijk P, Helbing WA, et al. Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs. Am J Physiol Heart Circ Physiol 2002;282(4):H1350-8.
- 10. Chen EP, Craig DM, Bittner HB, et al. Pharmacological strategies for improving diastolic dysfunction in the setting of chronic pulmonary hypertension. Circulation 1998;97(16):1606-12.