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Hu J, Deng Y, Dai P, Xie DW, Lan WF, Tan XL. Prognostic impact of right atrial strain in systemic lupus erythematosus with pulmonary arterial hypertension. Echocardiography 2024; 41:e15921. [PMID: 39254093 DOI: 10.1111/echo.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/25/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess right atrial (RA) function, including RA phase strain, via speckle-tracking echocardiography (STE) in a cohort of systemic lupus erythematosus (SLE) patients with pulmonary arterial hypertension (PAH) and in particular to explore the relationship between RA phase strain and the occurrence of cardiovascular events. METHODS STE analyses of RA function were evaluated in patients with SLE-PAH and in 33 healthy control subjects. Clinical associations, serum biomarkers, echocardiographic data, survival times, and adverse cardiovascular events were evaluated. RESULTS A total of 66 patients with SLE-PAH were enrolled; they were divided into two groups based on the occurrence of adverse clinical events. RA phase strain was significantly reduced in patients with events than in patients without events. The endpoint was defined as the combined outcome of all-cause mortality, right heart failure, and rehospitalization due to disease progression. During a mean follow-up of 17.2 ± 9.9 months, 23 patients (35%) reached the endpoint. Compared with patients with RA reservoir strain (RASr) ≥33.45%, patients with RASr < 33.45% had more adverse long-term outcomes (log rank p < .0001). RASr was independently associated with adverse clinical outcomes according to multivariate analysis (p = .010). CONCLUSION Our data suggest that RA function has prognostic value for SLE-PAH patients, and strain analysis revealed that the worse the RA function is, the worse the prognosis.
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Affiliation(s)
- Jie Hu
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Deng
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ping Dai
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dong-Wei Xie
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei-Fang Lan
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Lan Tan
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Granot Y, Ziv-Baran T, Berliner S, Topilsky Y, Aviram G. Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology. Acta Radiol 2023; 64:2518-2525. [PMID: 37448307 DOI: 10.1177/02841851231187065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Pressure overload of the right heart (pulmonary hypertension [PH]) can be an acute or a chronic process with various pathophysiologic changes affecting the dimensions of the heart chambers. The automatic four-chamber volumetric analysis tool is now available to measure the volume of the cardiac chambers in patients undergoing a computed tomography pulmonary angiogram (CTPA). PURPOSE To characterize the volumetric changes that occurred in response to increased systolic pulmonary arterial pressures (sPAP) in acute events, such as acute pulmonary embolism (APE), compared with other etiologies. MATERIAL AND METHODS Consecutive patients who underwent CTPA and echocardiography within 24 h between 2011 and 2015 were included. Differences in cardiac chamber volumes were investigated in correlation to the patients' sPAP. RESULTS The final cohort of 961 patients included 221 (23%) patients diagnosed with APE. The right (RV) to left (LV) ventricular volume ratio (VVR) was higher, while the left atrial (LA) volume index was smaller (P < 0.001) in the patients with APE. A decision tree for the prediction of APE showed that an RV to left VVR >2.8 was characteristic of APE, whereas an LA volume index >37.5 mL/m² was more compatible with PH due to other etiologies (P < 0.001). CONCLUSION The combination of VVR and LA volume index may help in differentiating between APE and chronic PH. CTPA-based volumetric information may be used to help clarify the underlying etiology of the dyspnea.
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Affiliation(s)
- Yoav Granot
- Department of Cardiology, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Aviram
- Department of Radiology, Tel Aviv Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li M, Lv Q, Wang S, Zhu S, Li H, Wu C, Dong N, Li Y, Zhang L, Xie M. Assessment of biatrial function in clinically well pediatric bicaval heart transplantation patients by three-dimensional echocardiography. Int J Cardiovasc Imaging 2020; 37:921-929. [PMID: 33048269 DOI: 10.1007/s10554-020-02067-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
Atrial size and function are closely correlated with atrial contributions to cardiovascular performance. Therefore, in this study, we aimed to assess atrial size and function in pediatric heart transplantation (HTx) patients using three-dimensional echocardiography (3DE). We enrolled 33 clinically well pediatric HTx patients and 33 healthy controls with a similar distribution of sex and age to the HTx patients. All patients underwent two-dimensional echocardiography (2DE) and 3DE. 2DE- and 3DE-derived biatrial maximal volume (Vmax), minimal volume (Vmin), ejection volume (EV), ejection fraction (EF), volume before atrial contraciton (VpreA), passive EV, passive EF, active EV and active EF were obtained in all patients. The 3D left atrail (LA) Vmax, Vmin and VpreA increased significantly in HTx patients after being indexed by BSA, while 3D LAEV and passive EV decreased significantly (P < 0.05). Moreover, the 3D LAEF, LA passive EF, and LA active EF all decreased significantly in HTx patients (P < 0.05). The 3D right atrial (RA) Vmax, Vmin, and VpreA increased significantly in HTx patients (P < 0.05), while the 3D RAEF and RA passive EF decreased significantly in HTx patients (P < 0.05). 3DE-derived LAVmax, LAVpreA, LA passive EV, LAEF, and LA passive EF were all lower than the corresponding 2D parameters. 3DE-derived RAVpreA, RA passive EV and RAEF were all lower than the corresponding 2D parameters. Atrial sizes and function assessed by 3DE- and 2DE-derived parameters, yield significantly discordant results in pediatric HTx patients. 3DE confirms significantly enlarged atrial sizes and decreased atrial functions in pediatric HTx patients.
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Affiliation(s)
- Meng Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuyuan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - He Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Liu K, Zhang C, Chen B, Li M, Zhang P. Association between right atrial area measured by echocardiography and prognosis among pulmonary arterial hypertension: a systematic review and meta-analysis. BMJ Open 2020; 10:e031316. [PMID: 32963060 PMCID: PMC7509969 DOI: 10.1136/bmjopen-2019-031316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this meta-analysis was to evaluate the association between enlarged right atrial area (RAA), as measured by echocardiography, and prognosis of patients with pulmonary arterial hypertension (PAH). DESIGN Systematic review and meta-analysis. DATA SOURCES To identify potential publications, a comprehensive literature search through MEDLINE, the Cochrane database and the Embase database was performed up to December 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they reported Cox regression based-HRs with 95% CIs for all-cause mortality or composite endpoint consisting of death and PAH-related events for echocardiography measurements of the RAA or the right atrial area index (RAAI) in patients with PAH. DATA EXTRACTION AND SYNTHESIS The unadjusted HR with 95% CI was extracted for the final pooled analysis. A random-effects model was used to determine the value of RAA/RAAI in the prognosis of patients with PAH. The data heterogeneity among the studies was estimated by the I2 statistic and the Cochran Q-statistic. RESULTS Twelve studies with a total of 1085 patients with PAH were finally included in the meta-analysis. These studies had a mean follow-up time ranging from 9.2 months to 5.0 years. Their findings showed that patients with PAH with enlarged RAA/RAAI were associated with poor prognosis. The risk of all-cause mortality in patients with PAH was found to statistically increase by 50% for every 5-unit increase in RAA/RAAI (HR 1.50, 95% CI 1.28 to 1.75, p<0.001). Similarly, the risk of the composite endpoint also significantly increased by 53% for every 5-unit increase in RAA/RAAI (HR 1.53, 95% CI 1.23 to 1.89, p<0.001). Subgroup analyses in which the patients were stratified by RAA and RAAI were consistent with the main results. CONCLUSION The meta-analysis suggested that enlarged RAA/RAAI were associated with increased risk of poor prognosis in patients with PAH.
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Affiliation(s)
- Ke Liu
- Department of General Surgery, Zhengzhou People's Hospital, Zhengzhou, Henan, China
| | - Chunhua Zhang
- Department of Emergency, Shangcai People's Hospital, Shangcai, Henan, China
| | - Bingyu Chen
- Department of Internal medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Mingfeng Li
- Department of Emergency, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Peican Zhang
- Department of Emergency, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
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