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Association of right atrial conduit phase with right ventricular lusitropic function in pulmonary hypertension

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Abstract

Alterations of right atrial (RA) function have emerged as determinants of outcome in pulmonary hypertension (PH). We aimed to clarify the pathophysiological associations of impaired RA conduit function with right ventricular (RV) function in PH. In 51 patients with PH (48 with pulmonary arterial hypertension), RA conduit function was assessed as echocardiographic peak early diastolic strain rate (PEDSR). PEDSR and cardiac magnetic resonance parameters were measured within 24 h of right heart catheterization and generation of pressure–volume loops to assess RV diastolic (RV end-diastolic pressure [EDP] and relaxation [Tau]) and systolic function. Spearman rho correlation and linear regression analysis were used to determine the association of PEDSR with RV function. The impact of PEDSR on time to clinical worsening was assessed using Kaplan–Meier and Cox regression analyses. Median (interquartile range) PEDSR was − 0.56 s − 1 (− 1.08 to − 0.37). Impaired PEDSR was significantly correlated with RV diastolic stiffness [EDP (rho = 0.570; p < 0.001) and Tau (rho = 0.500; p < 0.001)] but not with RV contractility or coupling. In multivariate linear regression including parameters of RV lusitropic and inotropic function, EDP remained independently associated with impaired PEDSR. During a median follow-up of 9 months, 23 patients deteriorated. After multivariate adjustment, PEDSR remained associated with clinical worsening (hazard ratio: 2.85; 95% confidence interval: 1.20–6.78). Altered RV lusitropy is associated with impaired RA conduit phase. PEDSR emerged as a promising, non-invasive, bedside-ready parameter to evaluate RV diastolic function and to predict prognosis in PH.

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Acknowledgments

We thank Claire Mulligan, PhD (Beacon Medical Communications Ltd, Brighton, UK) for editorial support, funded by the University of Giessen.

Funding

This work was funded by the Excellence Cluster Cardio-Pulmonary System (ECCPS) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Projektnummer 268555672—SFB 1213, Project B08.

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Author notes

  1. Manuel J. Richter and Federico Fortuni have contributed equally to this study.

Authors and Affiliations

  1. Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany

    Manuel J. Richter, Merle Antonia Wiegand, Antonia Dalmer, Hossein A. Ghofrani, Werner Seeger, Natascha Sommer, Henning Gall & Khodr Tello

  2. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100, Pavia, Italy

    Federico Fortuni & Stefano Ghio

  3. University of Arizona, Tucson, AZ, USA

    Rebecca Vanderpool

  4. Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Bad Nauheim, Germany

    Hossein A. Ghofrani

  5. Department of Medicine, Imperial College London, London, UK

    Hossein A. Ghofrani

  6. Erasme University Hospital, Brussels, Belgium

    Robert Naeije

  7. Department of Radiology, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Germany

    Fritz Roller

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  1. Manuel J. Richter
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Correspondence to Federico Fortuni.

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Conflicts of interest

Dr. Richter has received support from United Therapeutics and Bayer; speaker fees from Bayer, Actelion, Mundipharma, Roche, and OMT; and consultancy fees from Bayer. Dr Ghofrani has received consultancy fees from Bayer, Actelion, Pfizer, Merck, GSK, and Novartis; fees for participation in advisory boards from Bayer, Pfizer, GSK, Actelion, and Takeda; lecture fees from Bayer HealthCare, GSK, Actelion, and Encysive/Pfizer; industry-sponsored grants from Bayer HealthCare, Aires, Encysive/Pfizer, and Novartis; and sponsored grants from the German Research Foundation, Excellence Cluster Cardiopulmonary Research, and the German Ministry for Education and Research. Dr Naeije has relationships with drug companies including AOPOrphan Pharmaceuticals, Actelion, Bayer, Reata, Lung Biotechnology Corporation, and United Therapeutics. In addition to being an investigator in trials involving these companies, relationships include consultancy service, research grants, and membership of scientific advisory boards. Dr Seeger has received speaker/consultancy fees from Pfizer and Bayer Pharma AG. Dr Sommer has received fees from Actelion. Dr Gall has received fees from Actelion, AstraZeneca, Bayer, BMS, GSK, Janssen-Cilag, Lilly, MSD, Novartis, OMT, Pfizer, and United Therapeutics. Dr Tello has received speaking fees from Actelion and Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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The investigation conforms to the Declaration of Helsinki and was approved by the ethics committee of the Faculty of Medicine at the University of Giessen (Approval 108/15).

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Richter, M.J., Fortuni, F., Wiegand, M.A. et al. Association of right atrial conduit phase with right ventricular lusitropic function in pulmonary hypertension. Int J Cardiovasc Imaging 36, 633–642 (2020). https://doi.org/10.1007/s10554-019-01763-x

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