Değișik Etiyolojilere Bağlı ve Değișen Ciddiyetteki İkincil Pulmoner Hipertansiyonda Sağ Atriyumun Pompalama ve Depolama Fonksiyonları Korunmakta Ancak İletim Fonksiyonu Bozulmaktadır

Amaç: Pulmoner hipertansiyon (PHT) sağ ventrikül yetersizliği ve ölüme yol açabilen bir hastalıktır. PHT’de sağ atriyal fonksiyon ve boyutlardaki değișim hakkında az çalıșma vardır. Biz bu çalıșmada, değișik ciddiyet ve etiyolojilere bağlı sekonder PHT’de sağ atriyal fonksiyon ve boyutların nasıl değiștiğini belirlemeyi amaçladık. Gereç ve Yöntem: Bu çalıșmaya, sol ventrikül sistolik disfonksiyonu olmayan sol kalp hastalıkları, bağ dokusu hastalıkları ve kronik respiratuar hastalıklara sekonder 83 PHT hastası ve 49 yașa ve cinsiyete göre eșleștirilmiș sağlıklı kontrol alındı. Tüm deneklerde 2 boyutlu ekokardiyografi ve strain hızı ölçümü ile sağ atriyal depolama, iletim ve pompa fonksiyonları ve 2 boyutlu ekokardiyografik boyutlar değerlendirildi. PHT olan hastalar kontrol grubu ile ve kendi içlerinde karșılaștırıldı. Bulgular: PHT olan hastalarda kontrol grubuna oranla anlamlı șekilde sağ atriyal çaplar daha büyük ve sağ atriyal ejeksiyon fraksiyonu daha düșüktü. Orta ve ciddi PHT’de sağ atriyal ejeksiyon fraksiyonu kötüleșse de, sağ atriyal lateral duvar geç diastolik (atriyal sistolik) strain hızı farklı PHT ciddiyetlerinde korunmuș olarak bulundu. Artan PHT ciddiyeti ile birlikte, sağ atriyumun boșalma kabiliyetinin azaldığı ancak dolumunun sağlam kaldığı depolama/iletme oranında art ıș tespit edildi. Üç PHT etiyolojisinin sağ atriyal boyut ve fonksiyon yönünden farklılık göstermedikleri görüldü. Sonuç: Sonuçlarımız göstermektedir ki, sekonder PHT’de sağ atriyum sistolik fonksiyonu korunmakta ve sağ atriyum kanı ileten bir boșluktan daha çok depolayan bir boșluk haline gelmektedir. Bu değișiklikler hep birlikte sağ ventrikül önyükünün korunması ve böylece pulmoner ve sistemik debinin devam ettirilmesine yardım ediyor olabilirler. PHT etiyolojileri sağ atriyal fonksiyon ve boyutlarına etki etmiyor görünmektedir.

Right Atrium’s Pump And Reservoir Functions are Preserved But Conduit Function Impaired in Patients with Secondary Pulmonary Hypertension with Different Etiologies and Severities

Objective: Pulmonary hypertension (PHT) may result in right heart failure and death. Changes in right atrial function and size have been poorly studied in PHT. We aimed to determine how right atrial functions and size are affected in patients with secondary PHT with different severities and etiologies.Materials and Method: This study enrolled a total of 83 subjects with PHT secondary to left heart diseases excluding left ventricular systolic dysfunction, connective tissue disorders, and chronic respiratory diseases, and 49 healthy age- and sex-matched healthy controls. All subjects underwent 2-dimensional echocardiography and strain rate measurement to quantify right atrial size and function. Subjects with PHT were compared with the controls and with each other.Results: Subjects with PHT had significantly larger right atrial diameters and a significantly lower right atrial ejection fraction compared to controls. Although right atrial ejection fraction worsened in moderate and severe PHT, right atrial lateral wall late diastolic strain rate was preserved in different PHT severities. With increasing PHT severity, there occurred an increase in the right atrium’s reservoir/conduit ratio where right atrial emptying worsened but right atrial filling was preserved. The three PHT etiologies were comparable with respect to right atrial size and function.Conclusion: Our findings suggest that right atrium preserves its systolic function and behaves like more of a reservoir than a conduit in PHT. These changes together may help to increase right ventricular preload to sustain pulmonary and systemic output. PHT etiologies do not appear to exert any differential effect on right atrial function and size in PHT.

PDF

___

21. Denton CP, Cailes J, Philips G, Wells AU, Black CM, Bois RM. Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis. Br J Rheumatol 1997;36:239-243.
20. Bossone E, Avelar E, Bach DS, Gillespie B, Rubenfire M, Armstrong WF. Diagnostic value of resting tricuspid regurgitation velocity and right ventricular ejection flow parameters for the detection of exercise-induced pulmonary arterial hypertension. Int J Card Measurement. 2000;16:429-436.
19. Roca GQ, Campbell P, Claggett B, et al. Right Atrial Function in Pulmonary Arterial Hypertension. Circulation Cardiovascular measurement. 2015;8(11):e003521. doi:10.1161/CIRCMEASUREMENT.11 5.003521
18. Hoit BD, Shao Y, Gabel M. Left atrial systolic and diastolic function accompanying chronic rapid pacing-induced atrial failure. Am J Physiol 1998;275(1 Pt 2):H183-9.
17. Tabata T, Oki T, Yamada H, et al. Role of left atrial appendage in left atrial reservoir function as evaluated by left atrial appendage clamping during cardiac surgery. Am J Cardiol 1998;81(3):327-32.
16. Nishikawa Y, Roberts JP, Tan P, et al. Effect of dynamic exercise on left atrial function in conscious dogs. J Physiol 1994;481 ( Pt 2):457-68.
15. Hoit BD, Shao Y, Tsai LM, et al. Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling. Circ Res 1993;72(1):167-75.
14. Suga H. Importance of atrial compliance in cardiac performance. Circ Res 1974;35(1):39-43.
13. Cioffi G, de Simone G, Mureddu G, et al. Right atrial size and function in patients with pulmonary hypertension associated with disorders of respiratory system or hypoxemia. Eur J Echocardiogr 2007;8(5):322-31.
12. Cioffi G, Stefenelli C. 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 2002;90(6):601-6.
11. Gaynor SL, Maniar HS, Bloch JB, et al. Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation 2005;112(9 Suppl):I212-8.
10. Chen EP, Craig DM, Bittner HB, et al. Pharmacological strategies for improving diastolic dysfunction in the setting of chronic pulmonary hypertension. Circulation 1998;97(16):1606-12.
9. Leeuwenburgh BP, Steendijk P, Helbing WA, et al. Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs. Am J Physiol Heart Circ Physiol 2002;282(4):H1350-8.
8. Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 2002;39(7):1214-9.
7. Telagh R, Hui W, Abd El Rahman M, et al. Assessment of Regional Atrial Function in Patients with Hypertrophic Cardiomyopathies Using Tissue Doppler Measurement. Pediatr Cardiol. 2007 Sep 21 ; [Epub ahead of print].
6. Rudsky LG, Lai WW, Afilalo J, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
5. Quiñones MA, Otto CM, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002 Feb;15(2):167-84.
4. Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo. 2014.10.003.
3. Galiè N, Humbert M, Vachiery JL et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015 Oct;46(4):903-75. doi: 10.1183/ 13993003.01032-2015. Epub 2015 Aug 29.
2. Gorcsan J 3rd, Edwards TD, Ziady GM, et al. Transesophageal Echocardiography to Evaluate Patients With Severe Pulmonary Hypertension for Lung Transplantation. Ann Thorac Surg 1995 59: 717-722
1. Gaynor SL, Maniar HS, Prasad SM, et al. Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 2005;288(5):H2140-5.