Why the study?
RA dilatation and impaired RV filling are common in RV outflow tract dysfunction, but the correlations between atrial function, hemodynamics, and recovery of exercise capacity and RV pump function after PPVI were unclear.
Does percutaneous pulmonary valve implantation improve atrial function and does atrial performance predict recovery of exercise capacity and RV pump function in patients with right ventricular outflow tract dysfunction?
Does percutaneous pulmonary valve implantation improve atrial function and does atrial performance predict recovery of exercise capacity and RV pump function in patients with right ventricular outflow tract dysfunction?
PPVI leads to favorable right atrial remodeling and improved passive emptying function, though these changes do not predict improvements in exercise capacity or RV pump function.
Post-PPVI RA remodeling should not alter expectations for exercise or RV recovery; leaves open atrial parameters' prognostic value.
Background Right atrial (RA) dilatation and impaired right ventricular (RV) filling are common in patients with RV outflow tract dysfunction. We aimed to study potential correlations between atrial function with clinically relevant hemodynamic parameters and to assess the predictive impact of atrial performance on the recovery of exercise capacity and RV pump function after percutaneous pulmonary valve implantation (PPVI). Methods and Results Altogether, 105 patients with right ventricular outflow tract dysfunction (median age at PPVI, 19.2 years; range, 6.2-53.4 years) who underwent cardiac magnetic resonance imaging before and 6 months after PPVI were included. RA and left atrial maximal and minimal volumes as well as atrial passive and active emptying function were assessed from axial cine slices. RA emptying function was inversely related to invasive RV end-diastolic pressure, and RA passive emptying correlated significantly with peak oxygen uptake. After PPVI, a significant decrease in RA minimum volume was observed, whereas RA passive emptying function improved, and RA active emptying function decreased significantly. Patients with predominant right ventricular outflow tract stenosis showed more favorable changes in RA active and left atrial passive emptying than those with primary volume overload. None of the RA and left atrial emptying parameters was predictive for recovery of peak oxygen uptake or RV ejection fraction. Conclusions In patients with right ventricular outflow tract dysfunction, impaired RA emptying assessed by cardiac magnetic resonance imaging was associated with increased RV filling pressures and lower exercise capacity. PPVI leads to a reduction in RA size and improved passive RA emptying function. However, RA function was not associated with improved exercise performance and RV pump function.
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Latus et al. (2021) studied this question.
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