Chronic thromboembolic pulmonary hypertension was associated with significantly higher right atrial maximal volume index compared to healthy controls (43.46 vs 22.52 mL/m2; P<0.001).
Case-Control (n=121)
Does standard 2DE and M-mode echocardiography identify impaired right atrial function and predict disease severity in patients with CTEPH compared to healthy controls?
RAVmaxI and TAPSEra% measured by standard echocardiography are reliable noninvasive indices for quantifying CTEPH severity and identifying patients with advanced functional impairment.
Absolute Event Rate: 43.46% vs 22.52%
p-value: p=<0.001
ABSTRACT Background Chronic thromboembolic pulmonary hypertension (CTEPH) leads to right atrial (RA) dysfunction, which correlates with poor prognosis. However, most studies on RA function in pulmonary hypertension (PH) focus on heterogeneous PH etiologies, with limited data on CTEPH alone. This study aimed to assess RA function in CTEPH patients using standard two‐dimensional (2DE) and M‐mode echocardiography, and validate the clinical value of RA‐related parameters. Methods We enrolled 91 CTEPH patients and 30 healthy controls. RA volume/function parameters (maximal volume index RAVmaxI, total/passive/active emptying fractions TotEF/PassEF/ActEF) and tricuspid annular plane systolic excursion (TAPSE, decomposed into atrial TAPSEra and ventricular TAPSErv components; TAPSEra% = TAPSEra/TAPSE) were measured via 2DE/M‐mode echocardiography. Correlations with clinical (WHO functional class WHO‐FC, 6‐min walk distance 6MWD) and laboratory (NT‐proBNP) indices were analyzed; receiver operating characteristic (ROC) curves evaluated predictive value for WHO‐FC ≥ III. Results Compared to controls, CTEPH patients had higher RAVmaxI (43.46 ± 13.34 vs. 22.52 ± 2.89 mL/m 2 , P < 0.001), lower TotEF (39.45 ± 9.43 vs. 50.07 ± 7.52%, P < 0.001) and PassEF (14.33 ± 6.43 vs. 30.03 ± 5.26%, P < 0.001), and higher ActEV/TotEV (59.76 ± 17.37 vs. 34.05 ± 12.75%, P < 0.001). TAPSEra% was higher in CTEPH patients (58.69 ± 19.54 vs. 30.52 ± 7.92%, P < 0.001). RAVmaxI (≥37.47 mL/m 2 , AUC = 0.899, sensitivity = 75.4%, specificity = 91.7%) and TAPSEra% (≥45.05%, AUC = 0.849, sensitivity = 90.2%, specificity = 70.0%) effectively predicted WHO‐FC ≥ III (both P < 0.001). Conclusions Impaired RA reservoir and conduit functions are hallmarks of CTEPH, with compensatory active contraction counteracting the reduction in passive filling. Given their noninvasive nature and high reliability, RAVmaxI and TAPSEra% are valuable indices for identifying patients with WHO‐FC ≥ III and quantifying CTEPH severity, justifying their integration into standard echocardiographic protocols.
Sun et al. (Mon,) conducted a case-control in Chronic Thromboembolic Pulmonary Hypertension (n=121). Chronic thromboembolic pulmonary hypertension vs. Healthy controls was evaluated on Right atrial maximal volume index (RAVmaxI) (p=<0.001). Chronic thromboembolic pulmonary hypertension was associated with significantly higher right atrial maximal volume index compared to healthy controls (43.46 vs 22.52 mL/m2; P<0.001).
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