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:
CreatorsEmailORCIDORCID Put Code
Richter, Manuel J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zedler, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Berliner, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Douschan, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gall, HenningUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ghofrani, Hossein A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kimmig, LucasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kremer, NilsUNSPECIFIEDorcid.org/0000-0002-5615-0214UNSPECIFIED
Olsson, Karen M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brita da Rocha, BrunoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosenkranz, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seeger, WernerUNSPECIFIEDorcid.org/0000-0003-1946-0894UNSPECIFIED
Yogeswaran, AthiththanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rako, ZvonimirUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tello, KhodrUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
ADVERSE EVENTS; CONDUIT PHASE; ECHOCARDIOGRAPHY; ASSOCIATIONMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/59550

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