Effects of age and pulmonary arterial hypertension on the different phases of right atrial function.

To evaluate the effects of age and pulmonary hypertension on phasic right atrial function we measured right atrial volumes at 3 different points in the cardiac cycle in 57 healthy subjects and 33 patients with pulmonary arterial hypertension. Right atrial reservoir function was assessed by systolic filling volume and passive and active emptying by passive and active emptying volume and fraction of total emptying. We compared these phases of right atrial function in 30 healthy subjects <60 and 27 > or = 60 years old, and in a separate analysis, in 33 patients with pulmonary arterial hypertension and 33 matched controls. Healthy subjects > or =60 years had lower passive emptying fraction (46.0 +/- 23.3% vs 59.9 +/- 15.4%, P = 0.011) and larger active emptying volume (7.0 +/- 3.5 vs 4.9 +/- 2.5 ml/m2, P = 0.013 ) and fraction (54.0 +/- 23.3% vs 40.1 +/- 15.4%, P = 0.011) compared to those <60. Patients with pulmonary arterial hypertension had larger right atrial volumes, systolic filling volume (18.3 +/- 6.9 vs 12.3 +/- 4.9 ml/m2, P < or = 0.001) and active emptying volume and fraction (11.2 +/- 6.9 vs 5.4 +/- 3.0 ml/m2, P < or = 0.001; 60.7 +/- 29.9 vs 44.9 +/- 19.0%, P = 0.017 ) and smaller passive emptying fraction (39.3 +/- 29.9% vs 55.1 +/- 19.0%, P = 0.017) compared to controls. Aging and pulmonary arterial hypertension are associated with a decrease in passive right atrial emptying and an increase in right atrial active emptying.

Noninvasive differentiation of pulmonary arterial and venous hypertension using conventional and Doppler tissue imaging echocardiography.

To determine whether pulmonary arterial hypertension (PAH) and pulmonary venous hypertension (PVH) can be differentiated noninvasively, we reviewed data on 44 patients with pulmonary artery systolic pressure greater than or equal to 40 mm Hg by echocardiography and cardiac catheterization performed within 7 days of each other. Based on left ventricular end-diastolic pressure or pulmonary capillary wedge pressure, 20 patients were classified as having PVH and 24 as having PAH. Early (E) and late (A) diastolic mitral inflow velocities, deceleration time, early diastolic mitral annular velocity (E'), and E/A and E/E' ratios were remeasured in the two groups. Compared with patients with PAH, those with PVH had significantly higher E (107.8 +/- 27.3 vs 65.0 +/- 24.0 cm/s, P < .001), E/A (2.4 +/- 1.0 vs 0.9 +/- 0.4, P < .001), and E/E' (14.3 +/- 4.3 vs 5.1 +/- 1.9, P < .001), and significantly lower A (55.5 +/- 33.5 vs 74.1 +/- 20.8 cm/s, P < .001), E' (8.0 +/- 2.5 vs 13.1 +/- 3.6 cm/s, P = .001), and deceleration time (148.5 +/- 49.0 vs 192.3 +/- 41.9 milliseconds, P = .003). The area under receiver operating characteristic curve was 97% for E/E' and 91% for E/A. Optimal cutoff for diagnosing PVH was 9.2 for E/E' (sensitivity 95%, specificity 96%) and 1.7 for E/A (sensitivity 75%, specificity 91%). PAH and PVH may be differentiated by readily obtainable conventional and tissue Doppler parameters.