Effects of age and pulmonary arterial hypertension on the different phases of right atrial function

  • Howard J. Willens
  • Debra P. Fertel
  • Jianxin Qin
  • Eugenio Labrador
  • Maureen H. Lowery
Original Paper


To evaluate the effects of age and pulmonary hypertension on phasic right atrial function we measured right atrial volumes at 3 different points in the cardiac cycle in 57 healthy subjects and 33 patients with pulmonary arterial hypertension. Right atrial reservoir function was assessed by systolic filling volume and passive and active emptying by passive and active emptying volume and fraction of total emptying. We compared these phases of right atrial function in 30 healthy subjects <60 and 27 ≥ 60 years old, and in a separate analysis, in 33 patients with pulmonary arterial hypertension and 33 matched controls. Healthy subjects ≥60 years had lower passive emptying fraction (46.0 ± 23.3% vs 59.9 ± 15.4%, P = 0.011) and larger active emptying volume (7.0 ± 3.5 vs 4.9 ± 2.5 ml/m2, P = 0.013 ) and fraction (54.0 ± 23.3% vs 40.1 ± 15.4%, P = 0.011) compared to those <60. Patients with pulmonary arterial hypertension had larger right atrial volumes, systolic filling volume (18.3 ± 6.9 vs 12.3 ± 4.9 ml/m2, P ≤ 0.001) and active emptying volume and fraction (11.2 ± 6.9 vs 5.4 ± 3.0 ml/m2, P ≤ 0.001; 60.7 ± 29.9 vs 44.9 ± 19.0%, P = 0.017 ) and smaller passive emptying fraction (39.3 ± 29.9% vs 55.1 ± 19.0%, P = 0.017) compared to controls. Aging and pulmonary arterial hypertension are associated with a decrease in passive right atrial emptying and an increase in right atrial active emptying.


Right atrial function Aging Pulmonary arterial hypertension 



Maximum right atrial volume


Right atrial volume before atrial contraction


Minimum right atrial volume



This work was partially supported by the Schecter Family Foundation, Miami, Florida.


  1. 1.
    Stefanadis C, Dernellis J, Toutouzas P (2001) A clinical appraisal of left atrial function. Eur Heart J 22:22–36PubMedCrossRefGoogle Scholar
  2. 2.
    Spencer KT, Mor-Avi V, Gorscan J III et al (2001) Effects of aging on left atrial reservoir, conduit and booster pump function: a multi-institution acoustic quantification study. Heart 85:272–277PubMedCrossRefGoogle Scholar
  3. 3.
    Zhang Q, Kum LCC, Lee P-W et al (2006) Effect of age and heart rate on atrial mechanical function assessed by Doppler tissue imaging in healthy individuals. J Am Soc Echocardiogr 19:422–428PubMedCrossRefGoogle Scholar
  4. 4.
    Triposkiadis F, Tenolouris K, Androulakis A et al (1995) Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr 8:801–809PubMedCrossRefGoogle Scholar
  5. 5.
    Spencer KT, Mor-Avi V,Weinert L et al (1998) Age dependency of left atrial and left ventricular acoustic quantification waveforms for the evaluation of diastolic performance in left ventricular hypertrophy. J Am Soc Echocardiogr 11:1027–1035PubMedCrossRefGoogle Scholar
  6. 6.
    Erol MK, Yilmaz M, Mahmut A et al (2002) Left atrial mechanical function in patients with essential hypertension. Acta Cardiol 57:323–327PubMedCrossRefGoogle Scholar
  7. 7.
    Cioffi G, Mureddu GF, Stefenelli C et al (2004) Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension. J Hypertens 22:1589–1596PubMedCrossRefGoogle Scholar
  8. 8.
    Gottdiener JS, Kitzman DW, Aurigemma GP et al (2006) Left atrial volume, geometry,and function in systolic and diastolic heart failure of persons > 65 years of age (The Cardiovascular Health Study). Am J Cardiol 97:83–89PubMedCrossRefGoogle Scholar
  9. 9.
    Dernellis JM, Stefanadis CI, Zacharoulis AA et al (1998) Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations. Am J Cardiol 81:1138–1143PubMedCrossRefGoogle Scholar
  10. 10.
    Prioli A, Marino P, Lanzoni L et al (1998) Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. Am J Cardiol 82:756–761PubMedCrossRefGoogle Scholar
  11. 11.
    Klein Al, Leung DY, Murray RD et al (1999) Effects of age and physiological variables on right ventricular filling dynamics in normal subject. Am J Cardiol 84:440–448PubMedCrossRefGoogle Scholar
  12. 12.
    Spencer KT, Weinert L, Lang RM (1999) Effects of age, heart rate and tricuspid regurgitation on Doppler echocardiographic evaluation of right ventricular diastolic function. Cardiology 92:59–64PubMedCrossRefGoogle Scholar
  13. 13.
    Kukulski T, Hubbert L, Arnold M et al (2000) Normal regional right ventricular function and its change with age: a Doppler myocardial imaging study. J Am Soc Echocardiogr 13:194–204PubMedGoogle Scholar
  14. 14.
    Yu CM, Sanderson JE (1997) Right and left ventricular diastolic function in patients with and without heart failure: effect of age, sex, heart rate, and respiration on Doppler-derived measurements. Am Heart J 134:426–434PubMedCrossRefGoogle Scholar
  15. 15.
    Lambertz H, Krebs W, Schectem U et al (1985) Analysis of right atrium function in patients with chronic pressure overload of the right ventricle. Z Kardiol 74:402–408PubMedGoogle Scholar
  16. 16.
    Cioffi G, de Simone G, Mureddu G et al (2007) Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia. Eur J Echocardiogr 8:322–31PubMedCrossRefGoogle Scholar
  17. 17.
    Spencer KT, Garcia MJ, Weinart L et al (1999) Assessment of right ventricular and right atrial systolic and diastolic performance using automated border detection. Echocardiography 16:643–652 PubMedCrossRefGoogle Scholar
  18. 18.
    Gaynor SL, Maniar HS, Bloch JB et al (2005) Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation 112(suppl I):I-212–I-218Google Scholar
  19. 19.
    Kirchmer BJ, Himmelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496CrossRefGoogle Scholar
  20. 20.
    Cioffi G, Stefenelli C (2002) Comparison of left ventricular geometry and left atrial size and function in patients with aortic stenosis versus those with pure aortic regurgitation. Am J Cardiol 90:601–6PubMedCrossRefGoogle Scholar
  21. 21.
    Tsang TSM, Barnes ME, Bailey KR et al (2001) Left atrial volume: important risk marker for incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc 76:467–475PubMedCrossRefGoogle Scholar
  22. 22.
    Lin Y-J, Tai C-T, Kao T et al (2005) Electrophysiological characteristics and catheter ablation in patients with paroxysmal right atrial fibrillation. Circulation 112:1692–1700PubMedCrossRefGoogle Scholar
  23. 23.
    Dernellis J. (2001) Right atrial function in hypertensive patients: effects of antihypertensive therapy. J Hum Hypertens 15:464–470CrossRefGoogle Scholar
  24. 24.
    Lang RM, Bierig M, Devereux RB et al (2005) Chamber quantification writing group; American society of echocardiography’sguidelines and standards committee; European association of echocardiography.recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 18:1440–63PubMedCrossRefGoogle Scholar
  25. 25.
    Wang Y, Gutman JM, Heilbron D et al (1984) Atrial volume in a normal adult population by two-dimensional echocardiography. Chest 86:595–601PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Howard J. Willens
    • 1
    • 2
    • 4
  • Debra P. Fertel
    • 3
  • Jianxin Qin
    • 1
  • Eugenio Labrador
    • 1
  • Maureen H. Lowery
    • 1
  1. 1.Department of Medicine, Division of CardiologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Medicine, Cardiology SectionMiami VAMCMiamiUSA
  3. 3.Department of Medicine, Division of Pulmonary DiseasesUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.HollywoodUSA

Personalised recommendations