Unfavorable changes occur in the fetal myocardium in response to both maternal diabetes mellitus and obesity. The long-term prognostic implications of these changes require further study. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Background Elevated right atrial (RA) pressure is a risk factor for mortality and RA size is prognostic of adverse outcomes in pulmonary hypertension (PH). There is limited data on phasic RA function (reservoir, conduit, and pump) in pediatric PH. We sought to evaluate 1) the RA function in pediatric PH patients compared to controls, 2) compare the RA deformation indices with Doppler indices of diastolic dysfunction, functional capacity, biomarkers, invasive hemodynamics, and right ventricular (RV) functional indices, and 3) evaluate the potential of RA deformation indices to predict clinical outcomes. Methods and Results Sixty-six PH patients (mean age 7.9 ±4.7 years) were compared with 36 controls (7.7 ±4.4 years). RA and RV deformation indices were obtained using two-dimensional speckle tracking (2DCPA, TomTec). RA strain, strain rates, emptying fraction (EF), and RV longitudinal strain (LS) were measured. RA function was impaired in PH patients versus controls (p<0.001). There were significant associations between RA function with invasive hemodynamics (p<0.01). RA reservoir, pump function, the rate of RA filling, and atrial minimum volume predicted adverse clinical outcomes (HR (CI) 0.15 (0.03–0.73), p<0.01; 0.05 (0.003–0.43), p <0.004; 0.04 (0.006–0.56), p<0.01; 8.6 (1.6–37.2), p<0.01 respectively). Conclusions RA deformation properties are significantly altered in pediatric PH patients. Progressive worsening of RA reservoir and conduit functions are related to changes in RV diastolic dysfunction. RA reservoir function, pump function, the rate of atrial filling, and atrial minimum volume emerged as outcome predictors in pediatric PH.

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