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Right atrial emptying fraction non-invasively predicts mortality in pulmonary hypertension

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Abstract

Right-sided heart failure is the most common cause of death in pulmonary hypertension (PH). Echocardiographic measurements of right atrial (RA) size are associated with worse outcome in PH, however the association between RA function and death in PH has not been well-described. 160 PH patients (World Health Organization groups 1–5) underwent cardiac magnetic resonance imaging (cMRI) and right heart catheterization (RHC) within 6 weeks of each other at a tertiary care academic medical center in the United States. We measured cMRI RA maximum and minimum volumes indexed to body surface area and calculated RA emptying fraction (RAEF). We evaluated the relationship between RAEF and clinical variables with death using Cox proportional hazard models. 57 deaths occurred during a median follow-up of 3.5 years (36 % died overall, 10 % per year). RAEF was directly correlated in univariate analyses with right ventricular (RV) ejection fraction, left ventricular (LV) ejection fraction, LV size, cardiac index, absence of tricuspid and pulmonic regurgitation, absence of pericardial effusion, estimated glomerular filtration rate, 6-minute walk distance, and pulmonary arterial oxygen saturation, whereas it was inversely correlated with death, BNP, heart rate, mean RA pressure, mean PA pressure, pulmonary and systemic vascular resistance, RV size, and RA size. Using multivariate analyses, RAEF had a robust inverse association with death after adjusting for measured risk factors (HR per 5 % change in RAEF: 0.83 [95 % CI 0.73–0.94], p = 0.003). In PH patients, decreased RAEF by cMRI is independently associated with worse survival after adjustment for other risk factors.

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Author contribution

All authors contributed intellectually to this article. M.D., K.D., and S.M. primarily interpreted data and wrote the article. K.D., W.C., and S.M. contributed most to data collection. K.D. and C.A. contributed most to statistical analysis. K.C., F.T., and S.M. contributed most to initial study design. All authors have approved the final article for publication.

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    Authors and Affiliations

    1. Division of Cardiology, Department of Internal Medicine, Hartford Hospital, 85 Jefferson Street, Suite 208, Hartford, CT, 06106-2602, USA

      Konstadina Darsaklis

    2. Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA

      Matthew E. Dickson, William Cornwell III, Fernando Torres, Kelly M. Chin & Susan Matulevicius

    3. Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA

      Colby R. Ayers

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    1. Konstadina Darsaklis
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    Correspondence to Susan Matulevicius.

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    M.D., K.D., W.C.: None. K.C.: Research grants from Actelion, Bayer, Geon, Gilead, GlaxoSmithKline, NIH, Novartis, United Therapeutics; honoraria from Actelion, Bayer, Gilead. F.T.: Research grants from Akaria, Bayer, Geon, Gilead, Medtronic; consultant/advisory board with Actelion, Bayer, Gilead, LungLLC, Novartis, United Therapeutics. S.M.: Research grants from ACC/GE Healthcare Career Development Award, National Center for Advancing Translational Sciences, NIH, UT-STAR.

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    All procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study formal consent is not required.

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    Konstadina Darsaklis and Matthew E. Dickson have contributed equally to this work.

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    Darsaklis, K., Dickson, M.E., Cornwell, W. et al. Right atrial emptying fraction non-invasively predicts mortality in pulmonary hypertension. Int J Cardiovasc Imaging 32, 1121–1130 (2016). https://doi.org/10.1007/s10554-016-0883-3

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