Right Atrial Evaluation in Patients With Pulmonary Hypertension

Deng, Yan; Guo, Shu; Wang, Weifeng; Wang, Qian; Su, Hong-yue; Tan, Zhen; Wang, Fen; He, Qunyan

doi:10.7863/ultra.15.01028

Cited by 13 publications

(8 citation statements)

References 45 publications

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“…Both Willens et al and Cioffi demonstrated that RA volume was larger in patients with PH (19,20). Similar results were obtained by Deng et al (21), who employed 3D echocardiography, and by Sato et al who employed cardiac MRI-based volume assessment (22). Similar to those studies, our current study, which is based upon volumetric analysis of CTPA data, shows the association between RA volume and PH.…”

Section: Discussionsupporting

confidence: 89%

Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology

et al. 2023

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Background Pressure overload of the right heart (pulmonary hypertension [PH]) can be an acute or a chronic process with various pathophysiologic changes affecting the dimensions of the heart chambers. The automatic four-chamber volumetric analysis tool is now available to measure the volume of the cardiac chambers in patients undergoing a computed tomography pulmonary angiogram (CTPA). Purpose To characterize the volumetric changes that occurred in response to increased systolic pulmonary arterial pressures (sPAP) in acute events, such as acute pulmonary embolism (APE), compared with other etiologies. Material and Methods Consecutive patients who underwent CTPA and echocardiography within 24 h between 2011 and 2015 were included. Differences in cardiac chamber volumes were investigated in correlation to the patients’ sPAP. Results The final cohort of 961 patients included 221 (23%) patients diagnosed with APE. The right (RV) to left (LV) ventricular volume ratio (VVR) was higher, while the left atrial (LA) volume index was smaller ( P < 0.001) in the patients with APE. A decision tree for the prediction of APE showed that an RV to left VVR >2.8 was characteristic of APE, whereas an LA volume index >37.5 mL/m² was more compatible with PH due to other etiologies ( P < 0.001). Conclusion The combination of VVR and LA volume index may help in differentiating between APE and chronic PH. CTPA-based volumetric information may be used to help clarify the underlying etiology of the dyspnea.

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Section: Discussionsupporting

confidence: 89%

Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology

et al. 2023

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“…13 Increased right atrial pressure and volume leads to RA structural remodeling that manifests as chamber enlargement. Furthermore, RA enlargement may often occur before RV enlargement 14 due to the consequences of increased volume. Previous studies have demonstrated that changes in cardiac chamber volume may precede pressure changes in both the ventricles and atria.…”

Section: Discussionmentioning

confidence: 99%

Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair

Miller

Cutts

Donatelle

et al. 2022

Cathet Cardio Intervent

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Background In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr). Methods Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional‐hazard regression was created utilizing MR type, STS‐score, and RLR to assess the independent association of RLR with survival. Kaplan−Meier analysis was used to analyze the association between RAVI and LAVI with all‐cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups. Results Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow‐up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all‐cause mortality while patients with high LAVI and low RAVI had significantly improved all‐cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion‐hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all‐cause mortality [HR = 2.304; 95% CI = 1.26−4.21, p = 0.006] when MR type and STS score were accounted for. Conclusion Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS‐score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr.

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“…Another study illustrated that 3D echocardiography enables the measurement of RA volume and phasic function, highlighting its feasibility and consistency throughout the cardiac cycle [84]. In patients with PH, the volumetric assessment of the RA and the modifications in passive and active emptying fractions, particularly when precedes RV dilation, can become meaningful prognostic markers.…”

Section: Right Atrium Volume and Strainmentioning

confidence: 99%

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

Kadoglou,

Khattab,

Velidakis

et al. 2024

JPM

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The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s′), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.

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Right Atrial Evaluation in Patients With Pulmonary Hypertension

Abstract: Real-time 3DE is a feasible, repeatable, and noninvasive method for accessing cyclic RA volume and function changes, such as those that occur with varying RV status in patients with pulmonary hypertension.

Cited by 13 publications

References 45 publications

Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology

Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology

Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

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