Association of right atrial conduit phase with right ventricular lusitropic function in pulmonary hypertension

Manuel J. Richter, Federico Fortuni, Merle Antonia Wiegand, Antonia Dalmer, Rebecca Vanderpool, Hossein A. Ghofrani, Robert Naeije, Fritz Roller, Werner Seeger, Natascha Sommer, Henning Gall, Stefano Ghio, Khodr Tello

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Abstract

Alterations of right atrial (RA) function have emerged as determinants of outcome in pulmonary hypertension (PH). We aimed to clarify the pathophysiological associations of impaired RA conduit function with right ventricular (RV) function in PH. In 51 patients with PH (48 with pulmonary arterial hypertension), RA conduit function was assessed as echocardiographic peak early diastolic strain rate (PEDSR). PEDSR and cardiac magnetic resonance parameters were measured within 24 h of right heart catheterization and generation of pressure–volume loops to assess RV diastolic (RV end-diastolic pressure [EDP] and relaxation [Tau]) and systolic function. Spearman rho correlation and linear regression analysis were used to determine the association of PEDSR with RV function. The impact of PEDSR on time to clinical worsening was assessed using Kaplan–Meier and Cox regression analyses. Median (interquartile range) PEDSR was − 0.56 s − 1 (− 1.08 to − 0.37). Impaired PEDSR was significantly correlated with RV diastolic stiffness [EDP (rho = 0.570; p < 0.001) and Tau (rho = 0.500; p < 0.001)] but not with RV contractility or coupling. In multivariate linear regression including parameters of RV lusitropic and inotropic function, EDP remained independently associated with impaired PEDSR. During a median follow-up of 9 months, 23 patients deteriorated. After multivariate adjustment, PEDSR remained associated with clinical worsening (hazard ratio: 2.85; 95% confidence interval: 1.20–6.78). Altered RV lusitropy is associated with impaired RA conduit phase. PEDSR emerged as a promising, non-invasive, bedside-ready parameter to evaluate RV diastolic function and to predict prognosis in PH.

Original languageEnglish
JournalInternational Journal of Cardiovascular Imaging
DOIs
Publication statusAccepted/In press - Jan 1 2020

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Keywords

  • Peak early diastolic strain rate
  • Pulmonary hypertension
  • Right atrial function
  • Right atrial strain rate
  • Right ventricular diastolic stiffness

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Richter, M. J., Fortuni, F., Wiegand, M. A., Dalmer, A., Vanderpool, R., Ghofrani, H. A., Naeije, R., Roller, F., Seeger, W., Sommer, N., Gall, H., Ghio, S., & Tello, K. (Accepted/In press). Association of right atrial conduit phase with right ventricular lusitropic function in pulmonary hypertension. International Journal of Cardiovascular Imaging. https://doi.org/10.1007/s10554-019-01763-x