Abstract 13570: Right Atrial Volume and Reservoir Function are Novel Predictors of Clinical Worsening in Pulmonary Hypertension
Background: Left atrial size and function reportedly predict mortality in various left heart diseases. Conversely, no prior studies have examined if right atrial (RA) size and function predict clinical worsening in patients with pulmonary hypertension (PH).
Methods and results: We prospectively studied 68 consecutive patients with pre-capillary PH. RA volume and three RA functions (systolic, reservoir and conduit functions) were evaluated by ECG-gated cardiac magnetic resonance (CMR). We then examined the clinical value of the RA indices for the prediction of clinical worsening (CW) (defined as hospitalization due to right heart failure, lung transplantation, pulmonary endarterectomy, or PH-related death). Seventeen of 68 patients experienced CW during the mean follow-up of 19 months. According to the Kaplan-Meier curve, the rate of CW was significantly higher in patients with supramedian minimum RA volume index (>29.6 mL/m2) as compared with those with inframedian RA minimum volume (Fig A). Also, the rate of CW was higher in PH patients with inframedian RA reservoir volume index (≤ 7.1 mL/m2) as compared with those with supramedian RA reservoir volume index (Fig B). In univariate Cox hazard proportional analysis, the occurrence of CW was significantly associated with WHO functional class (WHO-FC) (Hazard ratio (HR) = 3.85), plasma brain natriuretic peptide concentration (HR 3.23), right ventricular (RV) diastolic volume index (HR 1.01), RV mass index (HR 1.03), RV ejection fraction (HR 0.96), RA minimum volume index (HR 1.01), and RA reservoir volume index (HR 0.80). In multivariate analysis, the occurrence of CW was significantly associated with WHO-FC (HR 3.36), RV ejection fraction (HR 1.09), RA minimum volume index (HR 1.06) and RA reservoir volume index (HR 0.73).
Conclusion: RA volume and reservoir function are novel independent predictors of clinical worsening including PH-related hospitalization and death in patients with pre-capillary PH.
- © 2013 by American Heart Association, Inc.