Right atrial size and deformation in patients with dilated cardiomyopathy undergoing cardiac resynchronization therapy.

ABSTRACT

AIMS: To evaluate right atrial (RA) morphology and deformation in patients with dilated cardiomyopathy (DCM). METHODS AND RESULTS: A total of 130 patients with either idiopathic (n = 70) or ischaemic (n = 60) DCM, and 60 controls underwent clinical examination, standard echocardiography, and RA two-dimensional strain echocardiography (2DSE). Six months after implantation of a cardiac resynchronization therapy (CRT) device, the DCM patients were re-evaluated, if their left ventricular (LV) end-systolic volume had decreased by at least 15% they were defined as echocardiographic responders. All DCM patients were in NYHA class III before CRT, with a mean LV ejection fraction of 29.2 +/- 5.5%. After CRT, 94 patients were in NYHA functional class I-II. The patients were subdivided into echocardiographic responders (n = 85) and non-responders (n = 45). Both RA area index (19.7 +/- 5.5 cm(2)/m in non-responders vs. 13.2 +/- 4.4 cm(2)/m in responders; P < 0.001) and RA strain of lateral wall (24.3 +/- 10.2% in non-responders vs. 40.2 +/- 8.9% in responders; P < 0.001) were significantly different between the two groups. A RA area index >or=16 cm(2)/m showed a sensitivity and specificity of 87.1 and 95.4%, respectively (P < 0.0001) to predict a negative response to CRT. By multivariable analysis, increased RA area index (P < 0.001), ischaemic aetiology of DCM (P < 0.01), and less severe radial intraventricular dyssynchrony were independent determinants of an unfavourable response to CRT. CONCLUSION: Right atrial area index was increased and RA myocardial deformation was impaired in patients with DCM who were non-responders to CRT.