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

Willens, Howard J.; Fertel, Debra; Qin, Jianxin; Labrador, Eugenio; Lowery, Maureen H.

doi:10.1007/s10554-008-9306-4

Cited by 52 publications

(48 citation statements)

References 24 publications

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“…For example, increase in the systolic function of the right atrium has been documented by two-dimensional measurements(13), by Doppler methods (17), and by pulsed tissue Doppler imaging (14). The increased RA EF in PH patients with WHO-FC III seen in the present study is consistent with these prior observations.…”

supporting

confidence: 89%

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Right atrial volume and phasic function in pulmonary hypertension

Sato

Tsujino

Oyama‐Manabe

et al. 2013

International Journal of Cardiology

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supporting

confidence: 89%

“…In 2008, an echocardiographic study by Willens et al demonstrated that RA volume was higher in PH patients than in controls (17). RA dilatation in PH was also shown in another echocardiographic report by Cioffi et al (13).…”

mentioning

confidence: 81%

Right atrial volume and phasic function in pulmonary hypertension

Sato

Tsujino

Oyama‐Manabe

et al. 2013

International Journal of Cardiology

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“…These three points in diastole were labeled RAmax (maximum RA volume in the cycle), RAp (RA volume before RA systole), and RAmin (minimum RA volume in the cycle), respectively, as described previously. 12 RA area and volume measurements were made in the apical 4-chamber view with digital calipers, by digitally tracing the RA endocardium (defined as the border between the echocardiographic signal of the RA endocardium [white] and the RV cavity [black]) at the corresponding points in 2 consecutive cardiac cycles (see Fig. 2) and averaging the values.…”

Section: Echocardiographic Techniquesmentioning

confidence: 99%

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

2016

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Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSE RA ) and that occurring before RA contraction (TAPSE RV ). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSE RA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects. Pulmonary arterial hypertension (PAH) is characterized by marked increases in right ventricular (RV) afterload, which if left untreated leads to progressive RV dysfunction, exercise intolerance, and potentially death.1-3 As recently emphasized by the International Right Heart Foundation Working Group, the right ventricle (also RV) is only one part of the total right heart system, and the other components, including the right atrium (RA), contribute importantly to total right heart function. 4It has been recognized that in the setting of RV failure, preserved right atrial (also RA) function is essential to maintain adequate total right heart function. After RV infarction, for example, preserved RA function has been shown to improve RV filling and performance, whereas diminished RA function compromises cardiac output. 5,6 Loss of atrial function, in the form of supraventricular arrhythmias with resulting atrioventricular dyssynchrony, is also known to be poorly tolerated among patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH). 7,8 Moreover, animal models have shown that RA systolic function is, in fact, augmented in the setting of RV ischemia and that if there is a subsequent ischemic insult to the RA, RV function is significantly reduced. 7 Taken together, these studies suggest that RA function must not only be maintained but at times augmented, in order to optimize total right heart function in the setting of RV c...

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“…However, data about the interaction of the RV with the right atrium (RA) are sparse. Studies (10,21,28) have been conducted that assessed components of RA function in animals and humans with pulmonary arterial banding or pulmonary hypertension. A study by Hui and coworkers (15) investigated TOF patients with a focus on late atrial active emptying, the so-called atrial kick.…”

mentioning

confidence: 99%

Integrated analysis of atrioventricular interactions in tetralogy of Fallot

Riesenkampff

Mengelkamp

Müeller

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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The atria play an important role in cardiac performance. We evaluated their function and the atrioventricular interaction in operated patients with tetralogy of Fallot (TOF). Twenty patients who had undergone surgical repair of TOF and seven controls were investigated. Patients had residual pulmonary but no major tricuspid valve insufficiency. Atrial and ventricular strain rates were obtained by echocardiographic speckle tracking. Cine MRI-derived volumetric analysis provided atrial and ventricular time volume and time volume change curves yielding emptying and filling parameters. In addition, at the atrial level, reservoir, conduit and pump function, and cyclic volume change were calculated. At the atrioventricular valve level, tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE, respectively) were measured by two-dimensional echocardiography. In the patients compared with controls, right ventricular end-diastolic volumes were increased and biventricular ejection fraction was decreased (all P < 0.05). Biventricular measures of early diastolic ventricular filling were at control levels, but in late diastole, right ventricular filling parameters and strain rates were decreased (P < 0.001). The maximal right atrial size was slightly but not significantly diminished, but cyclic volume change was significantly reduced (P < 0.0001). Pump and reservoir function were decreased (P < 0.05), and conduit function was elevated (P < 0.001). The left atrium showed reduced reservoir function and cyclic volume change (P < 0.05). TAPSE and MAPSE were also decreased (P < 0.05). There were statistically significant interdependencies between RV ejection fraction, TAPSE, and right atrial filling and emptying parameters (all P < 0.05). In TOF patients, moderate systolic and diastolic right ventricular dysfunction is associated with clearly impaired right atrial function. The left atrium is affected to a lesser extent.

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

Cited by 52 publications

References 24 publications

Right atrial volume and phasic function in pulmonary hypertension

Right atrial volume and phasic function in pulmonary hypertension

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

Integrated analysis of atrioventricular interactions in tetralogy of Fallot

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