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Sivak JA, Raina A, Forfia PR. Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension. Pulm Circ. 2016;6(3):322-8doi: 10.1086/687767.
Sivak, J. A., Raina, A., & Forfia, P. R. (2016). Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension. Pulmonary circulation, 6(3), 322-8. https://doi.org/10.1086/687767
Sivak, Joseph A, et al. "Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension." Pulmonary circulation vol. 6,3 (2016): 322-8. doi: https://doi.org/10.1086/687767
Sivak JA, Raina A, Forfia PR. Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension. Pulm Circ. 2016 Sep;6(3):322-8. doi: 10.1086/687767. PMID: 27683609; PMCID: PMC5019085.
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Pulm Circ. 2016 Sep;6(3):322-8. doi: 10.1086/687767.

Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension.

Pulmonary circulation

Joseph A Sivak, Amresh Raina, Paul R Forfia

Affiliations

  1. Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina, USA.
  2. Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
  3. Division of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA.

PMID: 27683609 PMCID: PMC5019085 DOI: 10.1086/687767

Abstract

Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSERA) and that occurring before RA contraction (TAPSERV). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSERA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects.

Keywords: echocardiography; right ventricular failure; tricuspid annular plane systolic excursion

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