Right Atrial Strain in the Assessment of Right Heart Mechanics in Patients with Heart Failure with Reduced Ejection Fraction

BACKGROUND: Cardiac catheterization is the gold standard for cardiopulmonary hemodynamic assessment, although its widespread use could be restricted due to its invasive nature. The aim of this study is to compare multiple echocardiography parameters, including right atrial (RA) strain, with right heart catheterization (RHC) data in patients with heart failure reduced ejection fraction (HFrEF) in the assessment of right heart hemodynamics. METHODS: Patients with HFrEF (defined by left ventricular ejection fraction [LVEF] ≤ 35%) were enrolled prospectively in this study. All patients underwent echocardiography and RHC. RA pressure (RAP), right ventricular end diastolic pressure (RVEDP), systolic pulmonary artery pressure (sPAP) and pulmonary vascular resistance (PVR) were calculated in RHC. Right ventricular (RV) diastolic and systolic function, RAP, RA size, sPAP and PVR were also measured by echocardiography. RESULTS: Fifty patients (36 men) aged 13–51 years with LVEF ≤ 35% were enrolled in this study. There was a significant correlation between echocardiography and catheterization data (r > 0.6, p < 0.001). The RV diastolic grading had significant relation with RA volume (p < 0.001) and RA strain (p < 0.001) in echocardiography, and with RVEDP (p = 0.01) and RAP (p < 0.001) in RHC. There were significant relations between the New York Heart Association classification and RV diastolic function grading (p < 0.001), with RA strain (p = 0.019), and size (p = 0.04). CONCLUSIONS: RA function, as assessed by strain imaging, correlates with right heart hemodynamics in patients with HFrEF.