Universität zu Köln

Richter, Manuel J., Zedler, Daniel, Berliner, Dominik, Douschan, Philipp, Gall, Henning, Ghofrani, Hossein A., Kimmig, Lucas, Kremer, Nils ORCID: 0000-0002-5615-0214, Olsson, Karen M., Brita da Rocha, Bruno, Rosenkranz, Stephan, Seeger, Werner ORCID: 0000-0003-1946-0894, Yogeswaran, Athiththan, Rako, Zvonimir and Tello, Khodr (2021). Clinical Relevance of Right Atrial Functional Response to Treatment in Pulmonary Arterial Hypertension. Front. Cardiovasc. Med., 8. LAUSANNE: FRONTIERS MEDIA SA. ISSN 2297-055X

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Abstract

Background: Right atrial (RA) function has emerged as an important determinant of outcome in pulmonary arterial hypertension (PAH). However, studies exploring RA function after initiation of specific pulmonary vascular treatment and its association with outcome in patients with incident PAH are lacking.Methods: RA peak longitudinal strain (PLS), passive strain (PS), and peak active contraction strain (PACS) were retrospectively assessed in 56 treatment-naive patients with PAH at baseline and during follow-up after initiation of specific monotherapy or combination therapy. Patients were grouped according to their individual RA functional response to treatment, based on change from baseline (Delta): worsened (first Delta-tertile), stable (second Delta-tertile), and improved (third Delta-tertile). The Spearman's rho correlation and linear regression analysis were used to determine associations. Time to clinical worsening (defined as deterioration of functional class or 6-min walking distance, disease-related hospital admission, or death) was measured from the follow-up assessment. The association of RA functional treatment response with time to clinical worsening was assessed using the Kaplan-Meier and the Cox regression analyses.Results: Median (interquartile range) time to echocardiographic follow-up was 11 (9-12) months. Of the 56 patients, 37 patients (66%) received specific dual or triple combination therapy. Delta RA PLS during follow-up was significantly associated with changes in key hemodynamic and echocardiographic parameters. The change of pulmonary vascular resistance, right ventricular (RV) end-systolic area, and global longitudinal strain were independently associated with Delta RA PLS. The median time to clinical worsening after echocardiographic follow-up was 6 (2-14) months [17 events (30%)]. In the multivariate Cox regression analysis, worsening of RA PLS was significantly associated with clinical deterioration (hazard ratio: 4.87; 95% CI: 1.26-18.76; p = 0.022). Patients with worsened RA PLS had a significantly poorer prognosis than those with stable or improved RA PLS (log-rank p = 0.012). By contrast, PS and PACS did not yield significant prognostic information.Conclusion: Treatment-naive patients with PAH may show different RA functional response patterns to PAH therapy. These functional patterns are significantly associated with clinically relevant outcome measures. Improvements of RA function are driven by reductions of afterload, RV remodeling, and RV dysfunction.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Richter, Manuel J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Zedler, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Berliner, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Douschan, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Gall, Henning UNSPECIFIED UNSPECIFIED UNSPECIFIED Ghofrani, Hossein A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kimmig, Lucas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kremer, Nils UNSPECIFIED orcid.org/0000-0002-5615-0214 UNSPECIFIED Olsson, Karen M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brita da Rocha, Bruno UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Seeger, Werner UNSPECIFIED orcid.org/0000-0003-1946-0894 UNSPECIFIED Yogeswaran, Athiththan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rako, Zvonimir UNSPECIFIED UNSPECIFIED UNSPECIFIED Tello, Khodr UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-595502
DOI:	10.3389/fcvm.2021.775039
Journal or Publication Title:	Front. Cardiovasc. Med.
Volume:	8
Date:	2021
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	2297-055X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ADVERSE EVENTS; CONDUIT PHASE; ECHOCARDIOGRAPHY; ASSOCIATION Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59550