Right heart function parameters in patients with Ebstein anomaly:Correlations of evaluation of echocardiography and MRI / 中国医学影像技术

Objective To explore the correlations of evaluations of right heart function parameters in patients with Ebstein anomaly(EA)using echocardiography and cardiac MRI.Methods Data of transthoracic echocardiography and cardiac MRI in 32 patients with EA confirmed by operation were retrospectively analyzed.The correlations of cardiac cavity size,right ventricular function and strain parameters obtained using echocardiography and the functional right ventricular(fRV)ejection fraction(EF)measured using MRI were explored.Results MRI fRV-EF in 32 cases of EA was(23.20± 7.61)％.Among echocardiographic parameters in 32 cases of EA,fractional area change(FAC)of fRV(r=0.347,P=0.015)was slightly,while global longitudinal strain(GLS)of fRV(r=0.801,P＜0.001)was highly positively correlated with MRI fRV-EF,respectively,whereas atrialized right ventricle(aRV)area/fRV area(r=-0.730,P=0.007)was highly negatively,aRV area/left ventricular area(r=-0.450,P=0.042)and right ventricular anterior-posterior diameter(r=-0.650,P=0.022)were both moderately negatively correlated with MRI fRV-EF.Both the left ventricular eccentricity index(r=-0.347,P=0.049)and Glasgow outcome scale extended(r=-0.336,P=0.024)obtained with echocardiography were slightly negatively correlated MRI fRV-EF.Conclusion Right heart function parameters in EA patients obtained with echocardiography were correlated with those of MRI fRV-GLS,among which aRV area/fRV area were highly positively correlated with MRI fRV-EF,hence having great value for evaluating right heart function in EA patients.

Application of Two-Dimensional Speckle Tracking Technique to Assess Right Heart Function and Right Ventricle-Pulmonary Artery Coupling in Rheumatoid Arthritis / 中国医学影像学杂志

Purpose To assess the right atrial and right ventricular strain and right ventricular-pulmonary artery(RV-PA)coupling in rheumatoid arthritis(RA)via two-dimensional speckle tracking.Materials and Methods Sixty patients with RA in the General Hospital of Ningxia Medical University from June 2020 to June 2022 were prospectively selected,and all RA patients were divided into three groups according to pulmonary artery systolic pressure(PASP),including group A(n=20 cases)with PASP<33 mmHg,group B(n=20 cases)with PASP 33-39 mmHg as mild ePH,and group C(n=20 cases)PASP≥40 mmHg,twenty healthy individuals were selected as the control group.All subjects underwent transthoracic echocardiography,and right atrial and right ventricular systolic function was assessed by two-dimensional speckle tracking technique,and RV-PA coupling was assessed noninvasively by right ventricular free wall strain/pulmonary artery systolic pressure(RV FWS/PASP),pulmonary function was analyzed by pulmonary function instruments.Spearman's analysis was used to analyze the correlation between right heart function and RV-PA coupling to pulmonary diffusion function.Results There were statistical differences in right ventricular base diameter,right atrium diameter,tricuspid annular plane systolic excursion,inferior vena cava diameter,PASP,right ventricular global strain,RV FWS,right atrium strain-reservoi,right atrium strain-conduit(S-CD),RV FWS/PASP among the four groups(F/H=2.369-74.880,all P<0.05).Right atrium strain-reservoi[(36.0±7.9)%vs.(30.9±7.8)%],right atrium S-CD[(19.9±6.9)%vs.(15.3±4.7)%]and RV FWS/PASP(0.96±0.19 vs.0.56±0.13)in group B were significantly lower than those of group A(t=2.040,2.262,7.704,all P<0.05).There was a good correlation between diffusing capacity of the lung for carbon monoxide single-breathmethod and right ventricular global strain,RV FWS,right atrium S-CD and RV FWS/PASP in RA patients(r=0.392,0.472,0.431,0.572,all P<0.05).Conclusion The more increases of pulmonary artery pressures,the more decreases of right heart function in RA patients,and the more uncoupling in RV-PA.Right heart dysfunction and right ventricle-pulmonary artery uncoupling have developed in RA patients with PASP 33-39 mmHg,with association of pulmonary diffusion dysfunction.

Correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension / 中国医师进修杂志

Objective:To explore the correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary hypertension.Methods:Eighty-four patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone admitted to the First Affiliated Hospital of Xinjiang Medical University during the period of February 2020 to June 2022 were selected as the study subjects, and they were divided into the effective group (63 cases) and the ineffective group (21 cases) according to the treatment effect. Right cardiac function parameters were measured by Philips iE33 color ultrasonography before treatment and 72 h after treatment. Logistic regression was used to analyze the risk factors affecting the treatment outcome of patients, and receiver operating characteristics (ROC) curve was used to analyze the predictive value of right atrial function parameters in the poor prognosis of patients with COPD complicated with pulmonary hypertension.Results:The main pulmonary artery diameter (MPA), right ventricular base transverse diameter (RVd1), right ventricular middle transverse diameter (RVd2), right atrial diameter (RAd) and right ventricular free wall thickness (RVWT) in the effective group were lower than those in the ineffective group: (2.65 ± 0.23) cm vs. (2.90 ± 0.44) cm, (3.46 ± 0.43) cm vs. (3.76 ± 0.72) cm, (3.48 ± 0.42) cm vs. (3.88 ± 0.69) cm, (3.53 ± 0.81) cm vs. (4.03 ± 1.20) cm, (0.63 ± 0.12) cm vs. (0.72 ± 0.21) cm; end-diastolic to end-systolic tricuspid ring displacement (TAPSE) was higher than that in the ineffective group: (2.08 ± 0.32) cm vs. (1.82 ± 0.46) cm, there were statistical differences( P<0.05). Logistic regression analysis showed that RVd1 increased ( OR = 3.717, P<0.05), RVd2 increased ( OR = 2.162, P<0.05), RAd increased ( OR = 2.838, P<0.05) and TAPSE reduction ( OR = 1.704, P<0.05) were risk factors for treatment failure in patients. The results of ROC curve showed that the area under the curve of RVd1, RVd2, RAd, TAPSE in predicting the therapeutic effect of COPD patients with pulmonary hypertension were 0.820, 0.831, 0.872, 0.909, respectively. Conclusions:The independent influencing factors of ineffective patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone are the increase of structural parameters of the right heart and the decrease of systolic function parameters. The therapeutic effect of patients can be evaluated clinically according to the level of each parameter.

Evaluation of right heart function in persistent pulmonary hypertension of the newborn by two-dimensional speckle-tracking imaging / 中华超声影像学杂志

Objective:To assess the altered right atrial(RA) function using two-dimensional speckle-tracking imaging(2D-STI) in patients with persistent pulmonary hypertension of the newborn(PPHN), and investigate the diagnostic value of different right heart strain parameters in PPHN.Methods:Ultrasound images of 42 newborns with clinically confirmed diagnosis of PPHN in the neonatal intensive care unit of Shenzhen Children′s Hospital (median gestational age 37 + 1 weeks, median age 6 d) and 30 normal newborns (control group, median gestational age 37 + 3 weeks, median age 6.5 d) from January 2020 to January 2023 were retrospectively analyzed, all with gestational age ≥34 gestational weeks. 2D-STI was applied to evaluate RA function: RA strain(RA LS) and area change fraction(RA FAC), where RA LS included RA reservoir strain (εs), RA conduit strain (εe) and RA active contract strain (εa), while evaluating right ventricle(RV) function: RV global longitudinal strain(RV GLS), RV FAC, etc. And the degree of pulmonary artery pressure(PAP) was assessed by tricuspid regurgitation velocity(TRV). The above parameters were compared between the PPHN group and the control group, and the correlations between RA function parameters, RV function parameters and PAP in PPHN group were analyzed. The area under ROC curve (AUC) was used to compare the accuracy of each parameter in the evaluation of impaired cardiac function in PPHN patients. Results:Compared with the control group, RA function (εs, εe, εa and RA FAC) were impaired in PPHN patients (all P<0.05). εs was positively correlated with RV GLS, RA FAC ( r=0.494, 0.356, both P<0.05) and negatively correlated with minimum right atrial area (RAA min), pulmonary artery diameter (PAD), and tricuspid annular internal diameter ( rs=-0.285, r=-0.495, -0.396; both P<0.05); εe was negatively correlated with PAD ( rs=-0.256, P<0.05); εa was positively correlated with RV GLS ( r=0.499, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.390, -0.380; both P<0.05); RA FAC was positively correlated with RV GLS ( r=0.365, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.439, -0.328; both P<0.05). RA LS and RA FAC had no correlations with TRV-estimated PAP ( P>0.05). ROC analysis showed that the sensitivity and specificity of εs<40.50% for diagnosing PPHN was 0.905 and 0.800, respectively, with an AUC of 0.929; the sensitivity and specificity of RV GLS<18.55% for diagnosing PPHN were 0.905 and 0.900, respectively, with an AUC of 0.963; εs combined with RV GLS was the best indicator for early detection of right heart functional impairment in PPHN, with sensitivity and specificity of 0.905 and 1.000, respectively, and AUC was 0.985. Conclusions:RA function and RV function are both impaired in PPHN patients. εs combined with RV GLS is the best indicator for early assessment of right heart function impairment and diagnosis of PPHN.

Evaluation of abnormalities in right atrial volume and function in patients with pulmonary hypertension by four-dimensional ultrasound automatic quantitation analysis / 中华超声影像学杂志

Objective:To evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension (PH) by four-dimensional automatic quantitation technique, and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC) of PH patients.Methods:Eighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group. All cases were divided into 3 groups according to the mean pulmonary arterial pressure (mPAP): mild PH group ( n=28), moderate PH group ( n=28), severe PH group ( n=28). Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group. The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique, including right atrial minimum volume index (RAVImin), right atrial maximum volume index (RAVImax), right atrial presystolic volume index (RAVIpreA), right atrial ejection fraction (RAEF), right atrial passive ejection fraction (RAPEF), right atrial active ejection fraction, RAAEF, longitudinal strains of right atrial reserve, conduit and systolic period (RASr, RAScd, RASct), circumferential strains of right atrial reserve, conduit and systolic period (RASr-c, RAScd-c, RASct-c). The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ. Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area (RAA), NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio (TAPSE/sPAP). Results:①Compared with the control group, RAEF, RAPEF, RASr, RAScd, RASr-c, RAScd-c were significantly decreased in mild, moderate and severe PH groups; while RAAEF, RASct, RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups, and the differences were statistically significant (all P<0.05). RAVImin, RAVImax, RAVIpreA gradually increased among the control, mild PH, moderate PH and severe PH groups, and the differences were statistically significant (all P<0.05). RAEF, RAPEF, RAAEF, RASr, RAScd, RASct, RASr-c, RAScd-c, RASct-c were decreased successively among mild, moderate and severe PH groups, and the differences were statistically significant (all P<0.05). ②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC ≥Ⅲ, and the cut-off value was 20.5% (AUC=0.914, P<0.001). ③Correlation analysis showed that RASr was correlated with RAA, NT-proBNP and TAPSE/sPAP ( r=-0.803, -0.621, 0.739; all P<0.001). Conclusions:The degree of right atrial function impairment increased in patients with mild, moderate and severe PH in turn. RASr is the best predictor of WHO-FC ≥Ⅲ in patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.

Correlation between right atrial volume and function and liver function grading in patients with hepatitis B cirrhosis by four-dimensional ultrasound automatic quantitation analysis / 中华超声影像学杂志

Objective:To evaluate right atrial (RA) volume and function in patients with hepatitis B cirrhosis by four-dimensional automatic quantitation analysis technique, and to explore its correlation with liver function grading.Methods:Ninety patients with hepatitis B cirrhosis who were clinically confirmed in Henan Provincial People′s Hospital from December 2020 to July 2021 were randomly enrolled as the research subjects. According to Child-Pugh liver function score criteria, the patients were divided into three groups: Child-Pugh A group ( n=31), Child-Pugh B group ( n=31), Child-Pugh C group ( n=28). Another 30 healthy volunteers with gender and age matched at the same period were selected as the control group. The RA maximum volume (RAVmax), RA minimum volume (RAVmin), RA presystolic volume (RAVpreA), RA maximum volume index (RAVImax), RA emptying volume (RAEV), RA ejection fraction (RAEF), RA reservoir longitudinal and circumferential strains (RASr, RASr-c), RA conduit longitudinal and circumferential strains (RAScd, RAScd-c), RA contraction longitudinal and circumferential strains (RASct, RASct-c) were obtained by four-dimensional automatic quantitation analysis technique. Spearman correlation analysis was used to explore the correlation between the volume and strain parameters of right atrium and liver function grading, and the independent correlation factors of RASr-c were analyzed by univariate and multivariate linear regression analyses. Results:Compared with the control group, Child-Pugh A and Child-Pugh B groups, RAVmax, RAVmin, RAVpreA, RAVImax, and RAEV were all increased in Child-Pugh C group (all P<0.05). Compared with control group, the absolute values of RASr, RASct, RASr-c and RASct-c were increased, and the absolute values of RAScd and RAScd-c were decreased in Child-Pugh A group (all P<0.05). Compared with control group, Child-Pugh A and Child-Pugh B groups, the absolute values of RASr, RAScd, RASct, RASr-c, RAScd-c and RASct-c were decreased in the Child-Pugh C group (all P<0.05). Correlation analysis showed that the volume and strain parameters of the right atrium were correlated with liver function grading. RASr-c was independently correlated with E/e, ALB and BNP(β=-0.543, 0.521, and -0.562 respectively, all P<0.05). Conclusions:During the compensatory stage in patients with hepatitis B cirrhosis, the RA functions of reservoir and contractile were increased, but the function of conduit was decreased. With the aggravation of liver cirrhosis, the RA functions of reservoir, conduit and contractile were all decreased. The four-dimensional volume and strain parameters of the right atrium were correlated with Child-Pugh liver function grading, and RASr-c was independently correlated with E/e, ALB and BNP.

Quantitative evaluation of right atrial function in fetuses with moderate to severe tricuspid regurgitation by two-dimensional speckle tracking echocardiography / 中华超声影像学杂志

Objective:To explore the application value of two-dimensional speckle tracking echocardiography (2D-STE) in measuring the global longitudinal peak strain of the right atrium (PRAGLS) in normal fetuses and evaluating PRAGLS in assessing right atrial function in fetuses with moderate and severe tricuspid regurgitation (TR).Methods:A total of 25 fetuses diagnosed with moderate and severe TR, who underwent fetal echocardiography at Run Run Shaw Hospital, Zhejiang University College of Medicine between October 2020 and May 2022, were selected as the case group. Their gestational age ranged from 25.00(24.00, 30.00)weeks. Additionally, 100 normal singleton fetuses were chosen as the control group, with a gestational age of 25.83(23.00, 28.75)weeks. Standard basal or apical four-chamber clips were acquired and inputted into TOMTEC-ARENA offline cardiac analysis software for analysis. The fetal PRAGLS values of the two groups were obtained, as well as the routine obstetric ultrasound measurements and fetal echocardiographic parameters of both groups: fetal heart rate (FHR), biparietal diameter (BPD), femur length (FL), aortic annulus inner diameter (AO), pulmonary annulus inner diameter (PA), PA/AO ratio, right atrial end-systolic length (RAESL), right atrial end-systolic diameter (RAESD), right atrial end-systolic area (RAESA), right ventricular end-diastolic diameter (RVEDD), and tricuspid annular plane systolic excursion (TAPSE). The peak TR velocity and pressure gradient were simultaneously measured in the case group.The differences in fetal PRAGLS and other parameters between the two groups were compared and analyzed. The correlation between fetal PRAGLS and gestational age (GA) and routine measurements was assessed for both groups. Intra- and inter-observer repeatability tests were conducted using the intragroup correlation coefficient (ICC).Results:A significant difference in PRAGLS was observed between the two groups ( t=11.55, P<0.01). The TAPSE difference between the two groups was also statistically significant ( Z=3.45, P=0.01). Notable differences were found in AO, PA, PA/AO, RAESL, RAESD, and RAESA between the two groups (all P<0.05), but no significant differences were identified in age, GA, FHR, BPD, FL, and RVEDD between the two groups (all P>0.05). PRAGLS in the control group exhibited a moderate negative correlation with GA ( r=-0.47, P<0.01) and were correlated with BPD, FL, AO, PA, RAESL, RAESD, RAESA, and RVEDD ( r=-0.50, -0.46, -0.39, -0.43, -0.45, -0.36, -0.43, -0.32, all P<0.05). No significant correlation was observed with maternal age, FHR, PA/AO, and TAPSE (all P>0.05). No significant correlation between PRAGLS and GA or other conventional parameters was found in the case group (all P>0.05). The inter-measurer and intra-measurer ICC of PRAGLS in the control group were 0.87 and 0.79, respectively, while the inter-measurer and intra-measurer ICC of PRAGLS in the case group were 0.94 and 0.97, respectively, demonstrating good consistency. Conclusions:2D-STE exhibits strong feasibility and reproducibility in assessing fetal atrial function.Fetuses with moderate and severe TR display decreased PRAGLS, suggesting impaired right atrial reservoir function. Right atrial strain introduces a novel method for evaluating fetal cardiac function.

Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia.

BACKGROUND: Few studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD. METHODS: We retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated. RESULTS: In infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e' and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e' and maximum RA volume index were not. CONCLUSIONS: Evaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.

Evaluation of early right ventricular dysfunction in patients with chronic obstructive pulmonary disease by echocardiography / 中华医学超声杂志（电子版）

Objective To investigate the value of echocardiography in assessing the right heart function of patients with chronic obstructive pulmonary disease (COPD). Methods Forty-four COPD patients who were treated in Beijing Anzhen Hospital of Capital Medical University, from April 2016 to April 2017, were selected as COPD group; and 12 healthy physical examiners were included in healthy control group during the same period. Patients were divided into COPD with pulmonary hypertension (PH) group and COPD without PH group. All subjects were routinely examined by transthoracic echocardiography. The parameters of right heart function of all subjects were measured by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). Independent sample t test was used to compare echocardiographic routine parameters and recommended parameters of ASE guideline between COPD group and healthy control group. One-way analysis of variance was used to compare the routine parameters of echocardiography and the recommended parameters of the ASE guide in the patients of COPD with PH group and COPD without PH group and the healthy control group. SNK-q test was used for comparison between groups. Results The right ventricle diameter (RVD) in group COPD was wider than that in healthy control group [(20.68±4.21) mm vs (18.17±1.75) mm], and the difference was statistically significant (t=2.92, P=0.005). There was no significant difference in the right ventricular outflow tract (RVOT), main pulmonary artery diameter (MPAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) between the COPD group and the healthy control group. Compared with the healthy control group, the diameter of right ventricle basal segment in the COPD group increased [(35.92±8.12) mm vs (27.75±3.17) mm], tricuspid annular plane systolic excursion (TAPSE) decreased [(19.61±4.08) mm vs (22.67±2.67) mm], right ventricular index of myocardial performance (RIMP) increased [(0.52±0.10) cm/s vs (0.43±0.04) cm/s)], and the differences were statistically significant (t=3.39, P=0.001; t=-2.44, P=0.019; t=4.31, P ＜ 0.001). There was no significant difference in right atrium area, E/A, E/E' and S' between COPD group and healthy control group. There was no significant difference in RVOT, RVD, MPAD, LVEDD, LVESD and LVEF in the patients of COPD with PH group and COPD without PH group and in the healthy control group. There was no significant difference in the right atrium area, E/A, E/E', TAPSE and S'. The right ventricular basal segment diameter and RIMP of COPD with PH group and COPD without PH group were higher than those of healthy control group [(37.99±9.66) mm, (34.47±6.70) mm vs (27.75±3.17) mm; (0.54±0.13) cm/s, (0.51±0.08) cm/s vs (0.43±0.04) cm/s]. The differences were statistically significant (q=6.960, 4.905, 5.796, 4.348, all P＜0.05). However, there was no significant difference in right ventricular basal segment diameter and RIMP between COPD with PH group and COPD without PH group. The RVWT of COPD with PH group was higher than that of COPD without PH group [(5.29±0.69) mm vs (4.54±0.70) mm], and the difference was statistically significant (t=3.313, P=0.002). Conclusions The method recommended in the ASE guidelines for this study was more sensitive than conventional methods for the detection of changes in the structure of the right heart. The change of the right ventricular structure was the first manifestation of right heart involvement in COPD patients, and then the systolic function of the right ventricle diminished. The long-term effect of pulmonary hypertension was thickening of the right ventricular wall at the early stage and then enlargement of the right ventricle.

Right Atrial Deformation in Predicting Outcomes in Pediatric Pulmonary Hypertension.

BACKGROUND: Elevated right atrial (RA) pressure is a risk factor for mortality, and RA size is prognostic of adverse outcomes in pulmonary hypertension (PH). There is limited data on phasic RA function (reservoir, conduit, and pump) in pediatric PH. We sought to evaluate (1) the RA function in pediatric PH patients compared with controls, (2) compare the RA deformation indices with Doppler indices of diastolic dysfunction, functional capacity, biomarkers, invasive hemodynamics, and right ventricular functional indices, and (3) evaluate the potential of RA deformation indices to predict clinical outcomes. METHODS AND RESULTS: Sixty-six PH patients (mean age 7.9±4.7 years) were compared with 36 controls (7.7±4.4 years). RA and right ventricular deformation indices were obtained using 2-dimensional speckle tracking (2DCPA; TomTec, Germany). RA strain, strain rates, emptying fraction, and right ventricular longitudinal strain were measured. RA function was impaired in PH patients versus controls (P<0.001). There were significant associations between RA function with invasive hemodynamics (P<0.01). RA reservoir, pump function, the rate of RA filling, and atrial minimum volume predicted adverse clinical outcomes (hazard ratio [HR], 0.15; confidence interval [CI], 0.03-0.73; P<0.01; HR, 0.05; CI, 0.003-0.43; P<0.004; HR, 0.04; CI, 0.006-0.56; P<0.01; and HR, 8.6; CI, 1.6-37.2; P<0.01, respectively). CONCLUSIONS: RA deformation properties are significantly altered in pediatric PH patients. Progressive worsening of RA reservoir and conduit functions is related to changes in right ventricular diastolic dysfunction. RA reservoir function, pump function, the rate of atrial filling, and atrial minimum volume emerged as outcome predictors in pediatric PH.

Prolonged Sinus Pauses upon Termination of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic and Electroanatomic Findings.

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients. Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs 99 ± 8.7 vs 94.5 ± 9.1 s; P=0.02). Group A's PP intervals were longer during adenosine triphosphate testing before ablation (4.6 ± 2.3 vs 1.7 ± 0.6 vs 1.5 ± 1 s; P <0.001) and after ablation (4.7 ± 2.5 vs 2.2 ± 1.4 vs 1.6 ± 0.8 s; P <0.001), and group A had more complex electrograms (11.4% ± 5.4% vs 9.3% ± 1.6% vs 5.8% ± 1.6%; P <0.001). Compared with group C, group A had significantly longer corrected sinus node recovery times at a 400-ms pacing cycle length after ablation, larger RA volumes (100.1 ± 23.1 vs 83 ± 22.1 mL; P=0.04), and lower conduction velocities in the high posterior (0.87 ± 0.13 vs 1.02 ± 0.21 mm/ms; P=0.02) and high lateral RA (0.89 ± 0.2 vs 1.1 ± 0.35 mm/ms; P=0.04). We found that patients with PSP upon termination of atrial fibrillation have RA electrophysiologic and electroanatomic abnormalities that warrant post-ablation monitoring.

Study of the changing of right atrial volume and phasic function and its clinical value in patients with pulmonary hypertension / 中华超声影像学杂志

Objective To evaluate the right atrial(RA)volume and phasic function using three-dimensional echocardiography(3DE),and to examine the clinical relevance in pulmonary hypertension(PH). Methods Fifty PH patients and 20 control subjects were studied.RA volume,including maximum RA volume(Vmax),minimum RA volume(Vmin)and the volume before active systolic(Vpre-A)were evaluated by 3DE.RA maximum volume index(VmaxI),total emptying volume index(TotEVI),passive emptying volume index(PassEVI)and active ejection fraction(ActEF)were calculated.The correlation between RAVmaxI and the parameters of RV structure,function,pulmonary hemodynamics were analyzed.Results Maximum RA volume index(RAVmaxI)was higher in WHO functional class(WHO-FC)Ⅲ,Ⅳ of PH patients than in controls(all P <0.01).TotEVI was significantly higher in PH patients than in controls (P<0.001),but PassEVI was lower in PH patients than in controls(P =0.01 1).ActEF was similar when comparing PH patients of WHO-FC Ⅱ with controls.ActEF increased in PH patients with WHO-FCⅢ as compared with controls(P =0.008)but reduced in advanced with WHO-FC Ⅳ patients(P <0.001).RAVmaxI correlated with the indices of right ventricular(RV)structure,function and RV cardiac output index(all P <0.05).Conclusions PH is associated with increased RA size,increased TotEVI,and decreased PassEVI.ActEF increases in PH patients with WHO-FC Ⅲ but decreases in patients with WHO-FCⅣ.RA systolic function plays an important role in compensating RV dysfunction.

The change of right atrial function in patients with pulmonary hypertension:a study with two-dimensional speckle-tracking echocardiography / 中华超声影像学杂志

Objective To assess the right atrial(RA) function using two-dimensional speckle-tracking echocardiography(2D-STE) and the value of predicting WHO functional class in patients with pulmonary hypertension(PH).Methods Fifty-four consecutive PH patients were studied and compared with a control group of 24 healthy volunteers.RA function was evaluated by 2D-STE,and the following parameters were recorded:an average longitudinal strain (LS) curve that included LSpos during RA filling and LSneg representing RA active contraction (their summation is LStot),the phasic RA volumes,total RA emptying fraction (TotEF),RA passive(PassEF) and active emptying fraction(ActEF).The associations between these indices and the results of invasive pulmonary hemodynamics,cardiac structure and function level were evaluated.Results LStot,TotEF,LSpos,PassEF were significantly lower in PH patients than in controls(all P<0.01).ActEF/TotEF were significantly higher in WHO functional class (WHO-FC) Ⅱ and WHO-FC Ⅲ patients than in controls(all P<0.05),while were lower in WHO-FCIV patients than in controls(P<0.001).Among PH patients,LStot was negatively correlated with greater RA size and RA pressure (all P<0.01).LStot was also associated with right ventricular (RV) functional and overload parameters.In receiver-operator characteristic analysis,RA LStot was of optimal accuracy for prediction of WHO-FC≥Ⅲ in PH patients (P=0.002).Conclusions PH is associated with impaired reservoir and conduit function,but active contract function of RA is enhanced in WHO-FC Ⅱ and WHO-FC Ⅲ patients,and reduced in WHO-FCIV patients.RA LStot confers an optimal predictive effect of poor WHO-FC in PH patients and indicating prognosis.

Effect of Three-dimensional Echocardiography for Evaluating Right Atrial Function in Patients After Atria Sepal Defect Closure / 中国循环杂志

Objective: To explore the effect of three-dimensional echocardiography (RT-3DE) for evaluating right atrial function in patients after atrial septal defect (ASD) closure. Methods: Our research included 2 group: ASD group,n=50 patients with successful ASD closure and Control group, n=30 normal subjects from physical examination. RT-3DE was conducted at pre-operation and at 3 days, 1 month, 3 months post-operation; the volume of right atrium before contraction (Vpre), minimum volume of the right atrium (Vmin), maximum volume of the right atrium (Vmax), total emptying volume of right atrium (Vt), total emptying volume fraction of right atrium (Ft), active emptying volume fraction (Fa) and passive emptying volume fraction (Fp) were measured and compared between 2 groups at pre- and post-operation respectively. Results: At pre-operation, compared with Control group, ASD group had increased Vmax, Vmin, Vpre, Vt, and Fa, while decreased Ft and Fp, allP0.05. Conclusion: ADS patients had abnormal volume and function in right atrium, the abnormalities could be improved at 3 days after ASD closure and could be recovered to normal level at 3 months after operation. RT-3DE has the important role for evaluating right atrial volume and function in patients after ASD closure.

Acurácia diagnóstica da onda P nas derivações de Lewis/Gallop para detecção das sobrecargas atriais / Diagnostic accuracy of the P wave in the Lewis and Gallop Leads for atrial enlargement detection

Fundamentos: A acurácia diagnóstica (AD) do eletrocardiograma (ECG) convencional para detecção das sobrecargas atriais (SA) é baixa. As derivações de Lewis (L) e Gallop (G) permitem melhor visualização da onda P no ECG. Objetivo: Verificar se os parâmetros da onda P nas derivações de Lewis e Gallop aumentam a acurácia diagnósticados critérios de SA do ECG convencional. Métodos: As características da onda P nas derivações de L e G foram padronizadas em 27 indivíduos saudáveis. Considerou-se como limite de normalidade o percentil 99 para esses parâmetros. Esses novos critérios foram avaliados em 117 pacientes através do ECG convencional e das derivações de L e G. As dimensões dos átrios pelo ecocardiograma foram consideradas padrão-ouro para definição das SA. Para determinação da AD de cada parâmetro utilizou-se a área sob a curva (AUC) ROC (receiver operating characteristic). Resultados: ECG convencional apresentou baixa AD para detecção das SA. O índice de Morris foi o único que mostrou AD significativa: AUC 0,57 (95%IC: 0,48-0,66); p=0,03. A inclusão da onda P>100 ms (L e G) não aumentou a AD para detecção de SA esquerda em relação aos critérios tradicionais: AUC 0,58 (95%IC: 0,50-0,65)vs. AUC 0,57 (95%IC: 0,49-0,65); p=0,80. A inclusão de onda P com amplitude >2mm (L) e/ou >3mm (G) tambémnão aumentou a AD para detecção de SA direita: AUC 0,53 (95%IC: 0,46-0,61) vs. AUC 0,53 (95%IC: 0,45-0,60); p=0,31.Conclusão: A inclusão da avaliação da onda P nas derivações acessórias de L e G não resultou em incremento da AD para detecção das SA.

Background: The diagnostic accuracy (DA) of the conventional electrocardiogram (ECG) for detecting atrial enlargement (AE) is low. Lewis (L) and Gallop (G) enable better viewing the P wave in the ECG.Objective: Checking whether the P wave parameters in the leads of Lewis and Gallop increase the diagnostic accuracy of the conventional ECG AE criteria. Methods: The P wave characteristics in the L and G leads were standardized in 27 healthy individuals. The percentile of 99 was considered as limit of normality for those parameters. These new criteria were evaluated in 117 patients through conventional ECG and the L and G leads. The atrial sizes under the echocardiogram were considered as golden standard for defining the AE. The areaunder the ROC (receiver operating characteristic) curve (AUC) was used for determining the DA of each parameter.Results: Conventional ECG presented low DA for detecting the AE. Morris index was the only showing significant DA: AUC 0.57 (95%CI:0.48-0.66); p=0.03. The inclusion of the P wave >100ms (L and G) has not increased the DA for detecting left AE compared to the traditional criteria: AUC 0.58 (95%CI: 0.50-0.65) vs. AUC 0.57 (95%CI: 0.49-0.65); p=0.80. Including P wave with amplitude >2 mm (L) and/or>3 mm (G) has not increased DA for detecting right AE either: AUC 0.53 (95%CI: 0.46-0.61) vs. AUC 0.53 (95%CI: 0.45-0.60); p=0.31. Conclusion: Including the P wave in the accessory leads of L and G did not result in increment of DA for detecting AE.

The correlation of right heart functional classification with right atrial deformation in patients with pulmonary arterial hypertension:a study with two-dimensional speckle tracking imaging / 中华超声影像学杂志

Objective To assess right atrial (RA)myocardial mechanics in pulmonary hypertension (PH ) patients using two-dimensional speckle tracking imaging (2D-STI ),and define the relationship between RA function and exercise capacity in PH patients.Methods Thirty-eight consecutive PH patients were studied and compared with a control group of 25 healthy volunteers.Peak atrial longitudinal strain (PALS)and strain rate of RA were measured in all subjects.PALS values were obtained by averaging all segments (global PALS)measured in the 4-chamber view.Results RA PALS was significantly lower in PH patients than in controls,and gradually reduced with the development of cardiac insufficiency.A significantly postive correlation between global PALS and 6-minute walk distance was found(P =0.003). Furthermore,global PALS demonstrated the highest diagnositic accuracy (AUC of 0.979 )and excellent sensitivity and specificity of 86.8% and 84.0%,respectively,to predict functional status using a cutoff value less than 38.08%.Conclusions RA deformation is significantly damaged in PH patients.RA reservoir function can be estimated using 2D-STI,and gradually decrease in PH patients with different WHO-functional class (WHO-FC).RA PALS is a powerful predictor of cardiac functional status and exercise capacity in PH patients.

Evaluation of right atrial function in patients with dilated cardiomyopathy and ischemic cardiomyopathy using two-dimensional speckle tracking imaging / 中华超声影像学杂志

Objective To evaluate right atrial function in patients with idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy (ICM) by using two-dimensional speckle tracking imaging (2D-STI).Methods Study population consisted of 31 patients with IDCM,30 with ICM and 30 healthy subjects.High frame rate two-dimensional images were recorded from the apical four chamber view.Right atrial global longitudinal strain (GLS) was measured using two-dimensional strain soft ware.Results Compared with the controls,left ventricular ejection fraction (LVEF),tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (RVFAC),right ventricular fractional shortening (RVFS) and tricuspid annular peak systolic velocity(S') decreased (P ＜0.05),while right ventricular myocardial performance index (MPI) increased in IDCM and ICM group.There were no significant differences for all above echocardiographic parameters between IDCM and ICM patients.Compared with the controls,right atrial GLS decreased significantly in patients with IDCM and ICM,even much lower in patients with IDCM (P ＜0.001).Conclusions Measurement of right atrial strain using 2DSTI could be used for the assessment of right atrial dysfunction in patients with ICDM and ICM.

Echocardiographic assessment of right heart in normal adults / 中华医学超声杂志（电子版）

Objective To discuss the value of echocardiography for the assessment of structure and function of right heart in normal Chinese adults Methods The structure and function of right heart was assessed by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). The echocardiographic data of right heart of 130 normal Chinese adults were analyzed to acquire the normal reference values of echocardiographic parameters and evaluate the differences of these results among different age groups. Results There were significant differences among different age groups for some of the parameters. Right atrium (RA) transverse diameter was greater in the middle-aged group than that in the young-aged group [(36.90±5.10) mm vs (33.90±5.20) mm, t=-2.79, P=0.006]. RA longitudinal diameter (RAL) and RA area (RAA) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(40.10±5.10) mm vs (42.90±5.10) mm, (43.40±5.60) mm, t=-2.51 and-2.91, P=0.013 and 0.004;(11.90±3.20) mm2 vs (13.40±2.90) mm2, (13.90±3.60) mm2, t=-2.24 and-2.90, P=0.027 and 0.004]. Parasternal long-axis right ventricule outflow tract (PLAX RVOT), parasternal short-axis right ventricule outflow tract (PSAX RVOT) and pulmonary artery diameter (PAD) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(24.20±3.00) mm vs (26.20±2.30) mm, (25.90±2.90) mm, t=-2.80 and-2.32, P=0.006 and 0.022;(24.70±3.00) mm vs (27.20±2.50) mm, (26.90±2.60) mm, t=-4.40 and -3.84, P=0.000 and 0.000; (20.60±2.00) mm vs (22.10±2.70) mm, (21.90±2.10) mm, t=-3.12 and-2.67, P=0.002 and 0.008]. RV lateral wall thickness was smaller in the young-aged group than that in the middle-aged and old-aged groups [(5.10±0.60) mm vs (5.60±0.60) mm, (5.40±0.70) mm, t=-3.12 and-2.22, P=0.02 and 0.028];DTI e wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(14.90±3.70) cm/s vs (10.90±3.10) cm/s, (11.10±2.60) cm/s, t=5.82 and 5.49, P=0.000 and 0.000]. DTI a wave was smaller in the young-aged group than that in the middle-aged and old-aged groups [(12.50±3.90) cm/s vs (14.60±3.70) cm/s, (16.60±3.60) cm/s, t=-2.79 and -5.04, P=0.007 and 0.000] and DTI a wave was smaller in the middle-aged group than that in the old-aged group (t=-2.26, P=0.02). Tricuspid E wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(0.61±0.11) m/s vs (0.51±0.11) m/s, (0.48±0.08) m/s, t=4.58 and 5.44, P=0.000 and 0.000]. E/A was greater in the young-aged group than that in the middle-aged and old-aged groups (1.45±0.30 vs 1.12±0.33, 1.10±0.27, t=4.58 and 5.44, P=0.000 and 0.000). No significant differences were found among different age groups in RV systolic function parameters, whereas a trend of decrease in RV diastolic function was detected. Conclusion Echocardiography can be useful in assessing the structure and function of right heart quantitatively.

Effect of systemic lupus erythematosus on right heart function evaluated by parameters recommended by the American Society of Echocardiography / 中华超声影像学杂志

Objective To evaluate the right heart dysfunction in SLE patients with/ without pulmonary arterial hypertension (PAH) using the parameters recommended by the American Society of Echocardiography (ASE),and to examine whether the right heart dysfunction is directly related to elevated pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR).Methods Study population composited of 43 patients with SLE.The patients were divided into two groups according to the PASP measured by echocardiography:Group A was 24 patients with PASP ≤35 mm Hg,Group B was 19patients with PASP＞35 mm Hg.Twenty-two healthy subjects with age and gender matched were set as control group.Routine transthoracic echocardiography study was performed on all patients and 26 parameters were measured in order to compare the differences of the parameters among the three groups.Results There were significant differences in 17 parameters among the three groups (P ＜0.05).Tricuspid annular plane systolic excurtion(TAPSE) and E/A ratio of tricuspid flow velocities in SLE patients without PAH significantly decreased compared to control group (P =0.04 and 0.03).There were significant differences in 11 parameters between SLE with and without PAH group (P ＜0.05).Multivariate logistic regression analysis indicated that after adjustment for age and gender,the patients with elevated PVR associated with a 6.18-fold increase in right ventricular dysfunction compared to the patients with normal PVR (P =0.02).Conclusions The impairment of right ventricular function in SLE patients was directly related to PVR and PASP.Elevation of PVR was an important predictor for right heart dysfunction.

Evaluation of right atrial function in patients with pulmonary hypertension by left atrial volume tracking technique / 中国医师进修杂志

Objective To probe into the application of left atrial volume tracking technique(LAVT)on the evaluation of right atrial function in patients with pulmonary hypertension.Methods Forty-one patients with pulmonary hypertension (pulmonary hypertension group) and 37 control subjects (control group) were involved.Right atrial maximal volume (RAVmax),right atrial presystolic volume(RAVpre),right atrial minimal volume (RAVmax),systolic right atrial filling rate (dv/dtS),early diastolic right atrial emptying rate(dv/dtE) and late diastolic right atrial emptying rate(dv/dtA) was derived by LAVT.Right atrial passive emptying volume (RAVp),right atrial passive emptying fraction (RAVpEF),right atrial active emptying volume (RAVa),right atrial active emptying fraction (RAVaEF),right atrial total emptying volume (RAVt)and right atrial total emptying fraction (RAVtEF) was calculated.All the right atrial volume parameter was corrected by body surface area to obtain right atrial volume index (RAVI).Results RAVImax,RAVImin,RAVIpre,RAVIt,RAVIa,dv/dtS and dv/dtA in pulmonary hypertension group was higher than that in control group [(78.39 ± 49.35) ml/m2 vs.(24.80 ± 11.91) ml/m2,(62.59 ± 46.56) ml/m2vs.(17.46 ± 8.40)ml/m2,(70.12 ± 48.03) ml/m2 vs.(20.02 ± 9.46) ml/m2,(18.77 ± 11.47) ml/m2 vs.(9.35 ± 6.74) ml/m2,(8.53 ± 9.81) ml/m2 vs.(3.25 ± 3.00) ml/m2,(145.85 ± 80.56) ml/s vs.(86.44 ± 48.46) ml/s,(155.63 ±126.47) ml/s vs.(67.74 ± 33.27) ml/s],and RAVIp in pulmonary hypertension group was lower than that in control group [(6.09 ± 5.16) ml/m2 vs.(10.23 ± 11.12) ml/m2],and there were significant differences (P ＜0.05).But there were no significant differences in RAVItEF,RAVIpEF,RAVIaEF and dv/dtE between two groups (P＞0.05).Conclusions In patients with pulmonary hypertension,right atrial booster pump function and reservoir function increases,while right atrial conduit function decreases.LAVT has a potential ability to evaluate right atrial function.