Right Atrial Function in Pulmonary Arterial Hypertension.
Right Atrial Function in Pulmonary Arterial Hypertension.
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DOI：
10.1161/circimaging.115.003521
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发表时间：
2015-11
期刊：
影响因子：
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通讯作者：
Shah AM
中科院分区：
文献类型：
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作者：
Querejeta Roca G;Campbell P;Claggett B;Solomon SD;Shah AM
右心房（RA）压升高是肺动脉高压（PAH）的既定预后指标。然而，很少有人知道在RA功能的扰动PAH。水库（RA纵向应变[RA LS]），导管（RA早期纵向应变率[LSR]），以及在65例PAH患者中，通过2D斑点追踪评估了（RA晚期LSR）时相，这些患者6分钟步行距离≤ 450米，尽管接受了至少两种肺动脉高压特异性药物治疗，但PVR >800达因·秒·cm-5，随机疗效研究（IMPRES）试验，并与30名年龄和性别相似的健康对照组进行比较。我们研究了RA功能指标与有创肺血流动力学、心脏结构和功能以及NT-proBNP的相关性。与对照组相比，PAH患者的RA LS和早期LSR减少（分别为27.1±11.6 vs 56.9±12.7，校正后p<0.001和−0.6±0.5 vs −1.5±0.5，校正后p<0.001），即使在校正RA面积和有创RA压力后，而RA晚期SR在两组之间相似（−1.4±0.7 vs −1.5±0.4，p=0.42）。在PAH患者中，RA LS恶化与RA大小（r=-0.50，p<0.0001）和压力（r=-0.37，p=0.002）增大相关，但与肺动脉压无关（r=-0.07，p=0.58）。RA LS恶化还与右心室扩大和功能障碍以及独立于RA大小和压力的较高NT-proBNP相关。PAH患者的右心房储血器和被动导管功能受损，与右心房大小和压力无关，可能反映右心室衰竭和过载。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00902174。
Elevated right atrial (RA) pressure is an established prognostic measure in pulmonary arterial hypertension (PAH). However, little is known about perturbations in RA function in PAH. Reservoir (RA longitudinal strain [RA LS]), conduit (RA early longitudinal strain rate [LSR]), and active (RA late LSR) phases were assessed by 2D speckle tracking in 65 patients with PAH, 6-minute walk distance ≤ 450 meters, and a PVR >800 dynes·sec·cm−5 despite therapy with at least two PAH-specific medications enrolled in the Imatinib in Pulmonary arterial hypertension, a Randomized Efficacy Study (IMPRES) trial, and were compared to 30 healthy controls of similar age and sex. We studied the association of RA functional measures with invasive pulmonary hemodynamics, cardiac structure and function, and NT-proBNP. RA LS and early LSR were reduced in PAH patients compared to controls (27.1±11.6 vs 56.9±12.7, adjusted p<0.001 and −0.6±0.5 vs −1.5±0.5, adjusted p<0.001, respectively) even after adjusting for RA area and invasive RA pressure, while RA late SR was similar between groups (−1.4±0.7 vs −1.5±0.4, p=0.42). Among PAH patients, worse RA LS correlated with greater RA size (r=−0.50, p<0.0001) and pressure (r=−0.37, p=0.002), but not pulmonary artery pressure (r=−0.07, p=0.58). Worse RA LS was also associated with right ventricular enlargement and dysfunction and higher NT-proBNP independent of RA size and pressure. RA reservoir and passive conduit functions are impaired in PAH, independent of RA size and pressure, and likely reflect RV failure and overload. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00902174.