ABSTRACT
Echocardiographic assessment of right atrial pressure (RAP) from inferior vena cava (RAPIVC) dimension may underestimate catheter-derived (RAPC). As right atrial (RA) deformation, measured by speckle tracking, is preload-dependent, we hypothesized that RA strain may improve estimation of RAPC. Right atrial strain components [RA reservoir function (ÆR), peak RA contraction (ÆCT) and RA conduit function (ÆCD)] were measured in 125 of 175 patients who had echocardiography and invasive measures of RAP (median difference 1 day). To determine whether RA strain measures differentiated patients with correct vs incorrect RAPIVC assessment, categories with RAPIVC values < 3, 8 and > 15 mmHg were compared with RAPC groups < 3, 4-7, 8-10, 11-14 and > 15 mmHg. Non-invasively determined RAP was significantly lower (p = 0.001) than invasively determined RAPC, with a weak correlation (r = 0.35, p < 0.001). RA strain components were associated with RA size, RV function and IVC size. In those with RAPIVC > 15 mmHg, half of patients were categorized into RAP < 10 mmHg. There were no significant differences in RA characteristics that differentiated patients in whom echocardiographic estimation of RAP was inaccurate. Right atrial strain measures were feasible, and had associations with RA size, RV systolic function and IVC size. Right atrial strain was significantly different between those with normal vs raised pressure, but it did not identify those with incorrect echocardiographic assessment of RAP.
Subject(s)
Atrial Function, Right/physiology , Atrial Pressure/physiology , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Aged , Aged, 80 and over , Cardiac Catheterization , Echocardiography , Female , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/physiopathology , Male , Middle AgedABSTRACT
Individual patient response to effective therapies for pulmonary hypertension (PAH) is variable and difficult to quantify. Consequently, management decisions regarding initiation and continuation of therapy are highly dependent on the results of investigations. Registry data show that changes in cardiac index, mean right atrial pressure, and mean pulmonary artery pressure have the greatest influence on survival. It is recognized that pulmonary artery pressure (PASP) responses to PAH-specific drugs are heterogeneous. However, follow-up testing is strongly focused on assessing changes in PASP and functional status (6-min walk). The goals of therapy, which should be highlighted in follow-up imaging, include not only reduction of PASP, decrease in pulmonary vascular resistance, and improvements in right ventricular function, cardiac output, and tricuspid regurgitation. This paper reviews the echocardiographic follow-up of pulmonary hypertension, and especially focuses on right ventricular function-a major determinant of outcome, for which reliable echocardiographic assessment has become more feasible.
