Impaired Right Atrial Strain is Associated with Decompensated Hemodynamics in Pulmonary Arterial Hypertension

Abstract

The transition of right ventricle (RV) from a compensated to decompensated state contributes to survival in pulmonary arterial hypertension (PAH). However, little is known about the significance of right atrial (RA) dysfunction on disease progression in PAH. In this context, there has been growing interest in markers of RA myocardial dysfunction. Speckle tracking echocardiography, which has been principally used to measure the myocardial strain, is technically challenging in the RA due to the thin atrial wall. Feature tracking cardiovascular magnetic resonance (FT-CMR) software designed to derive myocardial strain from CMR cine images has become available for measurements of atrial longitudinal strain. However, in subjects with relatively vigorous tricuspid annular motion, contour tracking of the RA free wall segment adjacent to the tricuspid valve is adversely affected and becomes the source of errors. In contrast to FT-CMR, we present a rapid assessable strain parameter that requires the automatic tracking of only 3 anatomical reference points – thus avoiding the segment contour tracking near the insertion of the anterior leaflet into the tricuspid annulus.