Author + information
- Received June 25, 2018
- Revision received August 15, 2018
- Accepted August 16, 2018
- Published online October 17, 2018.
- Snigdha Jain, MDa,
- Daniel Kuriakoseb,
- Ilaina Edelsteinb,
- Bilal Ansari, MBBSb,
- Garrett Oldland, MDc,
- Swetha Gaddam, MDb,c,
- Khuzaima Javaid, MDc,
- Pritika Manaktala, MDb,
- Jonathan Leeb,d,
- Rachana Miller, MDc,d,
- Scott R. Akers, MD, PhDc and
- Julio A. Chirinos, MD, PhDb,c,d,∗ ()
- aDepartment of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- bDepartment of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- cDepartments of Internal Medicine and Radiology, Corporal Michael J. Crescenz VAMC, Philadelphia, Philadelphia
- dDepartment of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Julio A. Chirinos, South Tower, Room 11-138, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
Objectives This study researched right atrial (RA) deformation indexes and their association with all-cause mortality among subjects with or without heart failure (HF).
Background Although left atrial dysfunction is well described in HF, patterns of RA dysfunction and their prognostic implications are unclear. Cardiac magnetic resonance (CMR) imaging can provide excellent visualization of the RA. We used CMR to characterize RA phasic function in HF and to assess its prognostic implications.
Methods This study prospectively examined 608 adults without HF (n = 407), as well as adults with HF with a reduced ejection fraction (HFrEF) (n = 105) or with HF with a preserved ejection fraction (HFpEF) (n = 96). Phasic RA function was measured via volume measurements and feature-tracking methods to derive longitudinal strain. All-cause death was ascertained over a median follow-up of 38.9 months. Standardized hazard ratios (HRs) were computed via Cox regression.
Results Measures of RA phasic function were more prominently impaired in subjects with HFrEF than those in subjects with HFpEF. In analyses that adjusted for demographic factors, HF status, left ventricular ejection fraction, right ventricular end-diastolic volume index, and right ventricular ejection fraction, RA reservoir strain (HR: 0.66; 95% confidence interval [CI]: 0.47 to 0.92; p = 0.0154), RA expansion index (HR: 0.53; 95% CI: 0.31 to 0.91; p = 0.0116), RA conduit strain (HR: 0.58; 95% CI: 0.40 to 0.84; p = 0.0039), and RA conduit strain rate (HR: 1.51; 95% CI: 1.02 to 2.220; p = 0.0373) independently predicted all-cause mortality. In contrast, RA booster pump function and RA volume index did not independently predict the risk of death.
Conclusions Phasic RA function is predictive of the risk of all-cause death in a diverse group of subjects with and without HF. RA conduit and reservoir function are independent predictors of mortality.
Dr. Chirinos was supported National Institutes of Health grants R56HL-124073-01A1, R01-HL-121510-01A1, and 5-R21-AG-043802-02, and a VISN-4 research grant from the Department of Veterans Affairs; has received consulting honoraria from Bristol-Myers Squibb, OPKO Healthcare, Fukuda Denshi, Microsoft, Ironwood Pharmaceuticals, Sanifit, Pfizer, Merck, and Bayer; has received research grants from the American College of Radiology Network, Fukuda Denshi, Bristol-Myers Squibb, Microsoft; and has been named as inventor in a University of Pennsylvania patent application for the use of inorganic nitrates and/or nitrites for the treatment of heart failure and preserved ejection fraction. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 25, 2018.
- Revision received August 15, 2018.
- Accepted August 16, 2018.
- 2018 American College of Cardiology Foundation
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