Right atrial global strain was significantly lower in pulmonary hypertension patients than controls (11.40% vs 25.72%, P<0.001) and strongly correlated with invasively measured cardiac index.
Case-Control (n=52)
Does right atrial two-dimensional speckle-tracking echocardiography correlate with hemodynamic and clinical deterioration in patients with suspected pulmonary hypertension?
Right atrial global strain assessed by speckle-tracking echocardiography correlates strongly with invasive hemodynamics and may help identify early functional impairment in pulmonary hypertension.
Absolute Event Rate: 11.4% vs 25.72%
p-value: p=< 0.001
AIMS: Increased right atrial size is related to adverse prognosis in pulmonary hypertension. The potential incremental value of right atrial function assessment is still unclear. We tested the relationship between right atrial two-dimensional speckle-tracking echocardiography impairment and hemodynamic, functional and clinical deterioration in patients with pulmonary hypertension. METHODS: We prospectively evaluated 36 patients (27 female, 9 male; mean age 68 ± 13 years) with suspected pulmonary hypertension undergoing right heart catheterization and 16 matched controls. All patients underwent baseline evaluation by New York Heart Association functional class, 6-min walking test, brain natriuretic peptide (BNP), and standard two-dimensional echocardiography in less than 48 h of right heart catheterization. Right atrial two-dimensional speckle-tracking echocardiography was assessed by averaging all segments in standard four-chamber apical view. RESULTS: Right atrial global integral strain was significantly lower in patients compared with controls (11.40 ± 5.22% vs. 25.72 ± 5.95 P < 0.001). Moreover, right atrial global strain, but not right atrial area or volume, was correlated with invasively measured cardiac index (CI) (r = 0.72; P < 0.0001) and pulmonary vascular resistances in all patients, even though stronger in subjects with precapillary pulmonary hypertension (r = -0.42, P = 0.018; r = -0.54, P = 0.007 respectively; P = 0.007). It was also correlated with New York Heart Association (P = 0.027), BNP (P = 0.002), and 6-min walking test (P = 0.006). After multivariate analysis including right atrial volume, tricuspid annular plane systolic excursion, left atrial strain, and BNP, right atrial global strain showed the strongest correlation with CI. Area under the curve optimal cutoff for predicting CI at least 2.4 l/min/m was 17% (area under the curve: 0.83, sensitivity: 90%, specificity: 54%). CONCLUSION: Right atrial global strain can identify right atrial functional impairment before structural changes and may be implemented in a comprehensive, noninvasive right heart assessment for diagnosis and follow-up of pulmonary hypertension patients.
Piccinino et al. (Tue,) conducted a case-control in Pulmonary hypertension (n=52). Right atrial global strain assessment vs. Matched controls was evaluated on Right atrial global integral strain (p=< 0.001). Right atrial global strain was significantly lower in pulmonary hypertension patients than controls (11.40% vs 25.72%, P<0.001) and strongly correlated with invasively measured cardiac index.