Copyright © 2006, The European Society of Cardiology
Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia
aDepartment of Cardiology, Echocardiography Laboratory, Villa Bianca Hospital, via Piave 78, 38100 Trento, Italy
bDepartment of Clinical and Experimental Medicine, Federico II University Hospital – School of Medicine, Naples, Italy
cCardiology Unit, S. Giovanni-Addolorata Hospital, Rome, Italy
dDepartment of Cardiology, S. Martino Hospital, Belluno, Italy
Received 5 February 2006; received in revised form 20 May 2006; accepted after revision 2 June 2006.
gcioffi{at}villabiancatrento.it
* Corresponding author. Tel.: +39 461 916 000; fax: +39 461 916 874.
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Abstract |
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Background and aim Pulmonary hypertension (PH) determines various adaptive changes in right ventricular (RV) geometry which may progressively lead to hypertrophy, mechanical dysfunction and dilatation with pump failure. Right atrium (RA) is theoretically involved in this physiopathological process, but its role has never been investigated. We hypothesized that RA increases volume and function to assist RV during the chronic pressure overload exposition due to PH.
Methods We prospectively enrolled 66 consecutive patients referred to our echolab with a diagnosis of PH [defined as pulmonary artery systolic pressure (PASP) >30mmHg] associated with disorders of the respiratory system and/or hypoxemia and normal RV systolic function. Ejection force was taken up as index of RA systolic function and calculated according to the Manning's formula. Thirty-three healthy subjects for whom PH was definitely excluded by echoDoppler evaluation were used as controls.
Results PASP was 42±10 and 20±8mmHg in PH patients and controls, respectively; p=0.00001). In comparison with controls, PH patients exhibited higher RA volume (37±13 vs 32±13ml, p=0.04) and RA ejection force (6.7±3.0 vs 3.5±1.8Kdynes, p=0.00001). Both variables were positively related to PASP (r=0.23 and 0.48, p=0.02 and 0.00001, respectively).
Conclusions In patients with chronic PH, RA size and systolic function significantly increase and parallel signs of activation of the Frank-Starling mechanism in both right chambers. The magnitude of these phenomena is positively related to PASP levels.
Keywords: Pulmonary hypertension; Right atrial size and function; Disorders of the respiratory system and/or hypoxemia; Echocardiography
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