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Right Atrial Function Predicts Clinical Outcome in Patients with Precapillary Pulmonary Hypertension
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2018-08-06 , DOI: 10.1016/j.echo.2018.05.015
Sophia Anastasia Mouratoglou , Konstantinos Dimopoulos , Vasileios Kamperidis , Christos Feloukidis , Alexandros Kallifatidis , Georgia Pitsiou , Ioannis Stanopoulos , Vasileios Grosomanidis , Stavros Hadjimiltiades , Haralambos Karvounis , George Giannakoulas

Background

Although the primary role of right atrial (RA) size in the diagnosis and risk stratification of precapillary pulmonary hypertension (PH) has been studied, little is known about the clinical significance of RA function. In line with studies assessing left atrial function in heart failure, the aim of this study was to introduce the RA function index (RAFi) and to explore its prognostic power in precapillary PH.

Methods

RA emptying fraction was calculated as (RA end-systolic volume − RA end-diastolic volume) × 100/(RA end-systolic volume). RAFi was calculated as (RA emptying fraction × right ventricular outflow tract velocity-time integral)/(RA end-systolic volume index). Patients were followed for the end point of clinical failure, which was defined as death, hospitalization because of PH, or disease progression.

Results

In total, 47 patients with precapillary PH were included. Mean RAFi was 16.1 ± 22.3%. Over a median follow-up period of 25 months (interquartile range, 9.5–41.1 months), 29 patients experienced clinical failure. Univariate Cox proportional-hazard analysis showed that RAFi was a predictor of clinical failure (hazard ratio, 0.935; 95% CI, 0.890–0.981; P = .007). Addition of RAFi to established predictors of outcomes, including 6-minute walk distance, N-terminal pro–B-type natriuretic peptide, and RA area, improved their prognostic power.

Conclusions

RAFi is an easily assessed echocardiographic parameter, which is strongly predictive of clinical outcomes in patients with precapillary PH. Further studies are needed to validate RAFi and define its role in clinical practice.



中文翻译:

右心房功能可预测毛细血管前高血压患者的临床结果

背景

尽管已经研究了右心房(RA)大小在毛细血管前肺动脉高压(PH)的诊断和风险分层中的主要作用,但对RA功能的临床意义了解甚少。与评估心力衰竭左心房功能的研究一致,本研究的目的是介绍RA功能指数(RAFi)并探讨其对毛细血管前PH的预后能力。

方法

RA排空分数计算为(RA收缩末期容积-RA舒张末期容积)×100 /(RA收缩末期容积)。RAFi计算为(RA排空分数×右心室流出道速度-时间积分)/(RA收缩末期容积指数)。对患者进行临床失败的终点随访,终点定义为死亡,因PH住院或疾病进展。

结果

总共纳入了47例毛细血管前PH患者。平均RAFi为16.1±22.3%。在25个月的中位随访期内(四分位间距9.5-41.1个月),有29例患者出现了临床衰竭。单因素Cox比例风险分析表明RAFi是临床失败的预测指标(风险比为0.935; 95%CI为0.890-0.981;P  = .007)。将RAFi添加到已确立的预后指标中,包括6分钟的步行距离,N端前B型利尿钠肽和RA面积,可改善其预后。

结论

RAFi是易于评估的超声心动图参数,可强烈预测毛细血管前PH患者的临床结局。需要进一步研究以验证RAFi并确定其在临床实践中的作用。

更新日期:2018-08-06
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