Three‐dimensional echocardiography to evaluate right atrial volume and phasic function in pulmonary hypertension

Objective Pulmonary hypertension ( PH ) impairs right ventricular ( RV ) systolic and diastolic function, which in turn induces compensatory changes in right atrial ( RA ) function; the diverse effects on RA function are subject to much debate. We hypothesized that RA function plays a more important role in compensating RV dysfunction, than mere prevention of clinical failure in patients with PH . Methods We studied 54 patients with PH and 23 healthy controls. RA volume, including maximum RA volume, minimum RA volume, and the volume before atrial systole, was evaluated by 3 DE . RA maximum volume index ( V max I), total emptying volume index (Tot EVI ), passive emptying volume index (Pass EVI ), and active ejection fraction (Act EF ) were calculated. Receiver operating characteristic curve analysis was used to determine the sensitivity and specificity of various cutoff levels of the variables measured for predicting World Health Organization functional class ( WHO ‐ FC ) IV in patients with PH . Results RA V max I in patients with PH was higher than that in controls. In patients with PH , the Tot EVI was significantly higher, while Pass EVI was significantly lower as compared to that in controls. Act EF was increased in patients with WHO functional class ( WHO ‐ FC ) III PH as compared to that in controls ( P  =   .003) but was reduced in more advanced cases ( WHO ‐ FC IV ). In addition, the area under the curve of 3D RA Act EF was larger than those of 2D RA Act EF , RA GLS , RA area, FAC , TAPSE , and RIMP ( P  < .01 for all) for predicting WHO ‐ FC IV . Conclusion We demonstrated that RA function plays a more important role in compensating RV dysfunction then mere prevention of clinical failure in PH .