The association of left atrial and ventricular strain and volumetric parameters with clinical, biohormonal, and hemodynamic data in patients with pulmonary arterial hypertension

Abstract

Objectives: This study aimed to demonstrate left atrial and left ventricular three-dimensional volume and two-dimensional strain characteristics and their relationship with clinical status, neurohormonal markers, and invasive parameters measured by right heart catheterization in patients with pulmonary arterial hypertension. Patients and methods: Thirty-one patients (16 females, 15 males; mean age: 42.3±15.0 years; range, 21 to 71 years) were enrolled in this cross-sectional study between June 2013 and January 2014. Transthoracic echocardiography and right and left heart catheterization were performed. B-type natriuretic peptide (BNP) and uric acid levels were evaluated. Patients were evaluated in two groups regarding the requirement of hospitalization in the one-year period, tricuspid annular plane systolic excursion (TAPSE) values, and right ventricle lateral wall tissue Doppler systolic velocity (St) values. A TAPSE <1.6 cm and an St <10 cm/sec were considered worse outcomes. Groups were compared in terms of hemodynamic, neurohormonal, and echocardiographic data. Results: Hospitalized patients had lower 6-min walk test values (332.80±135.46 vs. 449.75±73.49, p=0.01) compared to those who were not hospitalized. Hospitalized patients had higher BNP levels [145.85 (11.82-688.66) vs. 36.62 (8.76-880.88), p=0.02]. The 6-min walk distance had a significant effect on predicting hospitalization (p<0.05; CI: 0.64-0.99). Considering the odds ratio, it was illustrated that the 6-min walk distance had a 0.96-fold effect in hospitalized patients compared to patients who were not hospitalized. Patients with lower TAPSE values had a lower left atrial end-systolic volume (15.98±7.40 vs. 25.48±12.31, p=0.01) and a lower left atrial expansion index (58.88±42.1 vs. 142.14±73.38, p=0.01). Left atrial ejection fraction was significantly lower in patients with lower St values (0.37±0.13 vs. 0.54±0.13, p=0.001). Conclusion: Pulmonary arterial hypertension patients with lower TAPSE values tended to have a lower left atrial volume and left atrial volume index. The traditional parameters, such as BNP and 6-min walk test, were predictors of hospitalization in patients with pulmonary arterial hypertension.