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Master Thesis

Atrial strain in patients with pulmonary arterial hypertension associated with congenital heart disease

Abstract : Introduction: pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD). PAH has a major impact on mortality and morbidity, rising the burden of care in CHD patients. Atrial strain, already studied in PAH patients, has been related to clinical severity and adverse outcomes. The aim of the present study was therefore to assess the prognostic role and compare bi-atrial function in patients with CHD-PAH, PAH from other causes (n-PAH) and healthy controls. Methods and results: we included in this prospective cohort study 65 patients with CHD-PAH, 67 patients with n-PAH and 65 healthy volunteers matched on sex and age to CHD-PAH patients. Transthoracic echocardiography, clinical assessment, BNP measurement and 6MWT were performed at baseline. Classic echocardiographic measurements and atrial function studying the 3 different phases strain and strain rate were measured in both. Atrial strain parameters are decreased in patients with CHD-PAH as compared to healthy volunteers, especially the right atrial (RA) reservoir (RASR 29,67% vs 44,15%, p<0,0001) and conduit phase (RASCD -15,85 vs -28,52, p<0,0001), but also left atrial (LA) reservoir and conduit phases. Active contractile phase seems preserved in both PAH group. Atrial function was comparable between CHD-PAH and n-PAH patients. On univariate analysis, congenital heart disease, New York Heart Association (NYHA) class, BNP, LVEDD, TAPSE, RA area, pericardial effusion, RA ejection fraction, RASR, RASCD, LASR were significantly associated with death and/or transplant. On multivariate analysis, BNP, pericardial effusion, RA ejection fraction, RASR and RASCD were independently associated with death or transplantation. RA reservoir (RASR≤30%)or conduit (RASCD>-8%) strain identified patients with a more than 3-fold-increased risk of death or transplant. Conclusion: patients with CHD-PAH do not differ in atrial adaptation in comparison with n-PAH. Impaired RASR and RASCD identify high risk PAH patients. RA conduit or reservoir function impairment represent a severity marker of PAH, including in patients with CHD-PAH suggesting the importance of RV diastolic dysfunction. This might be an early marker of poor prognosis. Those new parameters of interest should be studied further.
Document type :
Master Thesis
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Contributor : Bibliothèque Universitaire de Médecine Nice Connect in order to contact the contributor
Submitted on : Thursday, October 14, 2021 - 1:31:11 PM
Last modification on : Tuesday, December 7, 2021 - 4:10:59 PM
Long-term archiving on: : Saturday, January 15, 2022 - 6:53:15 PM


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  • HAL Id : dumas-03377952, version 1


Julie Kraemer. Atrial strain in patients with pulmonary arterial hypertension associated with congenital heart disease. Human health and pathology. 2021. ⟨dumas-03377952⟩



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