Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m 2 ) and obese (n=136; body mass index ≥30 kg/m 2 ) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP ( P <0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index ( P =0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01578031.

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Exercise-Induced Pulmonary Hypertension in Sickle Cell Anemia: a Study with Exercise Stress Echocardiography

Blood ◽

10.1182/blood.v112.11.2488.2488 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2488-2488

Author(s):

Newton Nunes ◽

Orlando Campos ◽

Maria Stella Figueiredo ◽

Rodolfo Delfini Cancado ◽

Perla Vicari ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Left Atrial ◽

Stress Echocardiography ◽

Left Atrial Volume ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Exercise Induced

Abstract Background: Pulmonary hypertension (PH) at rest is a risk factor for death in patients with sickle cell anemia. Exercise treadmill stress echocardiography (ETSE) is able to detect latent PH. Objective: To investigate the occurrence of exercise-induced PH in patients with sickle cell anemia and normal pulmonary pressure (PP) at rest, and its relationship with clinical and echocardiographic variables. Design: observational transversal study. Patients and Methods: We studied 44 patients (22 men, mean age = 25.3 y.o.) with sickle cell anemia and normal PP at rest (tricuspid regurgitant jet velocity: TRV < 2.5 m/s). They were divided into 2 groups: (G1) normal PP after ETSE (TRV ≤ 2.7 m/s); G2: exercise-induced PH (TRV > 2.7 m/s). The cut off points of TRV at rest and exercise were derived from healthy control subjects, matched for age, sex, and body surface area. Data obtained from ETSE were correlated with clinical, echocardiographic and ergometric variables, including left atrial volume indexed for body surface area and E/E’ ratio derived from pulsed wave and tissue Doppler. Student’s t test e chi-square test were used for statistical analysis. Multivariate logistic analysis was used to determine the independent predictors of abnormal PP response to exercise. Statistical significance was defined as a p < 0.05. Results: The exercise-induced PH occurred in 57% of patients (G2), with levels of TRV ranging from 2.8 to 4.5 m/s (3.4 ± 0.4m/s), significantly higher than those observed in G1 (2.5 ± 0.3m/s, p < 0.001). Exercise-induced PH was significantly related to higher creatinine levels, larger right ventricular diastolic area, TRV ≥ 2.3m/s at rest, left atrial volume index ≥ 41ml/m2, and E/E’ ratio ≥ 6.3. When the multivariate analysis was performed, TRV at rest [OR 6.5 (1.3–33.6), p = 0.03], left atrial volume index [OR 6.4 (1.2–33.5), p = 0.03]; and E/E’ ratio [OR 5.6 (1.2–26.5], p = 0.03) remained independently related to exercise-induced PH. Conclusion: Patients with sickle cell anemia and normal PP at rest may exhibit exercise-induced PH which was independently related to increased baseline PP levels, increased left atrial volumes end indirect parameters of left ventricular and diastolic pressure. The clinical relevance of these findings deserves future studies.

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Elevated Left Atrial Volume Index Predicts Incident Atrial Fibrillation After Typical Right Atrial Flutter Ablation

Journal of Atrial Fibrillation ◽

10.4022/jafib.20200485 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Dhanunjaya Lakkireddy

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Left Atrial ◽

Left Atrial Volume ◽

Right Atrial ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Atrial Flutter Ablation

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Abstract 17191: Left Atrial Volume Index and E/E’ Predict Predominance of Post-Capillary Pulmonary Hypertension With Exercise Hemodynamics

Circulation ◽

10.1161/circ.142.suppl_3.17191 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Naga Dharmavaram ◽

Aurangzeb Baber ◽

Sofia C Masri ◽

Ravi Dhingra ◽

James Runo ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Left Atrial ◽

Cardiopulmonary Exercise Testing ◽

Left Atrial Volume ◽

Venous Hypertension ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Group 2 ◽

Group 1

Introduction: Post-capillary pulmonary hypertension (PH) is diagnosed with rest hemodynamics and requires management of left heart disease. However, in subclinical PH and mixed PH (mixed pre- and post-capillary), it is imperative to identify a predominant post-capillary phenotype with exercise (aka. Pulmonary venous hypertension). Hypothesis: In suspected subclinical and mixed PH, greater left atrial volume index (LAVI; >35) and E/E’ (>8) on echocardiogram can reliably predict a predominant post-capillary PH with exercise, assessed with invasive cardiopulmonary exercise testing (iCPET). Methods: We reviewed clinical, echocardiographic and iCPET data for 37 patients undergoing exercise right heart catheterization and then analyzed the data with receiver operator curve (ROC) and area under the curve (AUC) analysis to estimate the different echo parameters to identify post-capillary PH. Results: Within the cohort, mean age (± SD) was 63.6±11.3 years, and 19 subjects were female (51%). On ROC analysis, LAVI and E/E’ had high predictive ability to identify a pulmonary venous hypertension response with exercise (AUC=0.860, p=0.003 for LAVI, and AUC=0.788, p=0.014) with optimal cut-offs identified as: LAVI >35 and E/E’ >8. These variables also notably had a significant association with PCWP/CO>2. To understand the hemodynamics associated with these differentiable echo features, we divided the overall cohort (n=37) into 2 groups: group 1 ( Abnormal-LA group ) =LAVI>35 and/or E/E’ >8, group 2 ( Normal-LA group )=LAVI≤ 34 and E/E’≤8. The LAVI in group 1 vs group 2 was: 44.3±15.2 vs 23.1±4.4 (p<0.001) and E/E’ was: 15.8±9.9 vs 7.7±1.95 (p<0.01). Results are summarized in Table 1. Conclusions: Among individuals with suspected PH, LAVI>35 and E/E’ >8 are reliable non-invasive markers to identify post-capillary PH. In a patient with a new diagnosis of PH based on screening echocardiogram, LAVI≤ 34 and E/E’≤8 may identify a patient who is likely to benefit from PH drugs.

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