Right atrium’s pump and reservoir functions are preserved but conduit function ımpaired in patients with secondary pulmonary hypertension with different etiologies and severities

• Published in: Ankara Ueniversitesi Tip Fakültesi mecmuasi Vol. 71; no. 1; pp. 35 - 42
• Main Authors: Çiftçi,Orçun, Özer,Necla, Atalar,Enver, Övünç,Kenan, Aksöyek,Serdar
• Format: Journal Article
• Language: English
• Published: Ankara Üniversitesi Tıp Fakültesi 01-01-2018
• Subjects: Sağlık Hizmetleri; Tıp; Ankara; Türkiye; strain rate; strain hızı; right atrium; echocardiography; ekokardiyografi; Pulmoner hipertansiyon; sağ atriyum; Pulmonary hypertension
• ISSN: 0365-8104; 1307-5608
• DOI: 10.1501/Tıpfak_000000994

Objective: Pulmonary hypertension (PHT) may result in right heart failure and death. Changes in right
atrial function and size have been poorly studied in PHT. We aimed to determine how right atrial
functions and size are affected in patients with secondary PHT with different severities and etiologies.
Materials and Method: This study enrolled a total of 83 subjects with PHT secondary to left heart
diseases excluding left ventricular systolic dysfunction, connective tissue disorders, and chronic
respiratory diseases, and 49 healthy age- and sex-matched healthy controls. All subjects underwent 2-
dimensional echocardiography and strain rate measurement to quantify right atrial size and function.
Subjects with PHT were compared with the controls and with each other.
Results: Subjects with PHT had significantly larger right atrial diameters and a significantly lower right
atrial ejection fraction compared to controls. Although right atrial ejection fraction worsened in
moderate and severe PHT, right atrial lateral wall late diastolic strain rate was preserved in different
PHT severities. With increasing PHT severity, there occurred an increase in the right atrium’s
reservoir/conduit ratio where right atrial emptying worsened but right atrial filling was preserved. The
three PHT etiologies were comparable with respect to right atrial size and function.
Conclusion: Our findings suggest that right atrium preserves its systolic function and behaves like
more of a reservoir than a conduit in PHT. These changes together may help to increase right
ventricular preload to sustain pulmonary and systemic output. PHT etiologies do not appear to exert
any differential effect on right atrial function and size in PHT.