BackgroundThe transition of right ventricle (RV) from a compensated to decompensated state contributes to survival in pulmonary arterial hypertension (PAH). This study investigates the significance of right atrial (RA) dysfunction on disease progression in PAH.MethodsEighty patients with PAH, including 58 with hemodynamically compensated RV function (PAH-C) and 22 with decompensated RV function (PAH-D), were compared with 80 age-matched and sex-matched normal controls. RA longitudinal strain and strain rate (SR) parameters corresponding to reservoir (total strain ε_s and strain rate SR_s), conduit (passive strain ε_e and strain rate SR_e), and booster pump (active strain ε_a and strain rate SR_a) phases were derived by a rapid semiautomated method on cine cardiovascular magnetic resonance.ResultsIn PAH compared with controls, significantly reduced RA strains and SRs were observed. Among patients with PAH, PAH-D had significantly impaired RA strains and SRs compared with PAH-C. RA total strain and passive strain were the best parameters for differentiating PAH-D from PAH-C. Lower RA strain correlated with increased RA pressure (r=−0.57; P<0.0001), RV volume (r=−0.37; P=0.002) and biomarker (r=−0.53; P<0.0001), impaired RV function (r=0.46–0.72; P<0.0001), and lower exercise capacity (r=0.41; P<0.0001). Reduced RA strains were significantly associated with higher risk of clinical worsening in PAH. RA passive strain was the best predictor of a composite adverse event end point (Harrell’s C statistic,0.75; hazard ratio,0.84; P=0.019) compared with other conventional RA and RV functional measurements.ConclusionsRA phasic functions are impaired in PAH. Among patients with PAH, impaired RA strains reflect RV decompensation and higher risks and predict adverse clinical outcomes.Clinical Trial Registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT02790918.

中文翻译：

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受损的心血管磁共振衍生的快速半自动右心房纵向应变与肺动脉高压的代偿性血流动力学相关。

背景右心室（RV）从补偿状态过渡到失代偿状态有助于肺动脉高压（PAH）的生存。方法研究80例PAH患者，其中58例具有血流动力学补偿的RV功能（PAH-C）和22例失代偿性RV功能（PAH-D） 80个年龄匹配和性别匹配的正常对照。RA的纵向应变和应变率（SR）对应于贮存器的参数（总应变ε_小号和应变率SR_小号），导管（被动应变ε _Ë和应变率SR _ë），和增压泵（活性应变ε_一个和应变率SR_一个）相通过快速半自动方法上电影衍生心血管磁性resonance.ResultsIn PAH与对照，显著降低RA菌株和SRS进行观察对比。在PAH患者中，PAH-D与PAH-C相比，RA株和SR明显受损。RA总应变和被动应变是区分PAH-D和PAH-C的最佳参数。较低的RA应变与RA压力增加（r = -0.57; P <0.0001），RV体积（r = -0.37; P = 0.002）和生物标志物（r = -0.53; P <0.0001），RV功能受损（r = 0.46-0.72；P<0.0001），并降低运动能力（r = 0.41；P <0.0001）。RA株减少与PAH临床恶化的较高风险显着相关。与其他常规RA和RV功能测量相比，RA被动应变是复合不良事件终点的最佳预测指标（Harrell's C统计量，0.75；危险比，0.84；P = 0.019）。在PAH患者中，受损的RA株反映了RV代偿失调和更高的风险，并预测了不良的临床结果。唯一标识符：NCT02790918。