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. 2016 Sep;6(3):322-8.
doi: 10.1086/687767.

Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension

Joseph A Sivak  1 , Amresh Raina  2 , Paul R Forfia  3
Affiliations

Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension

Joseph A Sivak et al. Pulm Circ. 2016 Sep.

Abstract

Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSERA) and that occurring before RA contraction (TAPSERV). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSERA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects.

Keywords: echocardiography; right ventricular failure; tricuspid annular plane systolic excursion.

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Figures

Figure 1
Figure 1
M-mode tracing of the tricuspid annulus in a pulmonary arterial hypertension patient (A) and a subject with a normal echocardiogram (B). TAPSERA accounts for the proportion of TAPSE (tricuspid annular plane excursion) owed to right atrial (RA) function alone; TAPSERV accounts for right ventricular (RV) shortening without the influence of RA contraction. Note the significantly larger contribution of TAPSERA to the total TAPSE in the PAH patient (A), compared to the normal subject (B).
Figure 2
Figure 2
Four-chamber views of a representative echocardiogram in a normal subject. In end-systole (A), the right atrium (RA) is at its largest volume, and the right ventricle (RV) is at its smallest volume. During early diastole (B), the tricuspid valve opens, and the right atrium has emptied a significant amount of its volume. At end-diastole (C), the atria are contracting, and the tricuspid annulus is being pulled further toward the right atrium, resulting in additional volume displacement from the right atrium. LA: left atrium; LV: left ventricle.
Figure 3
Figure 3
Tricuspid annular plane excursion (TAPSE, in cm) in both normal and pulmonary arterial hypertension (PAH) cohorts, separated into TAPSERA (during right atrial contraction) and TAPSERV (before right atrial contraction) components.
Figure 4
Figure 4
Left ventricular stroke volume in the normal (A) and pulmonary arterial hypertension (PAH; B) cohorts, with the contribution of active right atrial (RA) emptying volume highlighted.
See this image and copyright information in PMC

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