Study On The Right Atrium’ Function In Different State Of Right Ventricular’ Function In Patients With Chronic Pulmonary Artery Hypertension

Objective:To assess the change of right atrium’ function in differentstate of right ventricular’ function in patients with chronic pulmonary arteryhypertension use echocardiography,and to search the main factor whichinfluence the change of right atrium’ function.Methods:1. The study include20healthy participants as the controlgroup and57patients with chronic pulmonary artery hypertension as theexperimental group.（1） The patients were divided into three group by rightventricular ejection fraction（RVEF）.①g roup A：40%＜RVEF≤55%（n=19,mean age of47.47±14.47years），②g roup B：25%＜RVEF≤40%（n=19,mean age of50.42±15.93years），③g roup C：RVEF≤25%（n=19,mean age of48.11±14.63years）.2.A set of color Dopplerultrasonic system（ACUSON SC2000） was used,and the4D-function analysissoftware was available for quantitative analysis of RVEF.3.Allechocardiography studies were performed with the subjects lying in the leftlateral decubitus position connected with electrocardiogram（ECG）.And all thedata was recorded in3continuous cardiac cycle and were stored in hardwarefor off-line analysis.3.12D ECG:The right ventricular anteriorwall（RVAW）were measured in parasternal left ventricular long axisview;Measure the tricuspid annular plane systolic excursion（TAPSE） in apical4-chamber view;Using biplane area-length method,maximal RAvolume（Vmax）,minimal RA volume（Vmin）， pre atrial contraction RAvolume（Vprea）were measureed；Using the date above，we can calculate RAreservoir volume（RV），RA conduit volume（CV），RA contraction—chamber volume（CCV）；If EDV、Vmax、Vmin、Vprea were divided by body surfacearea（BSA），we can get maximal RA volume index（VmaxI），minimal RAvolume index（VminI），pre-atrial contraction RA volume index（VpreaI），reservoir volume index （RVI）， conduit volume index（CⅥ），contraction-chamber volume index（CCVI）.3.2Doppler ECG（PW、 CW、Color）:In systolic phase，the gradient pressure between two sides of tricuspidvalve can be measured，referring to the internal diameter and the collapse-rateof inferior vena cava（IVC）， wecan obtain pulmonary arterial systolicpressure（PASP）.The right ventricular outflow velocity-timeintegral（TVIROVT） were measured in parasternal left ventricular short axisview;combined with tricuspid valve’regurgitation velocity,we can getpulmonary vascular resistance（PVR）.3.3TVI ECG:Get apical4-chamberview，enter TVI mode．With the samp volume at RV free wall of valve ring，press PW,we can get tissue doppler frequency spectrum（S、E、A）．Tei indexand Ea/Aa were calculated.3.43D ECG:Get apical4-chamber view，enter3Dmode,put the right ventricular in the center of the screen.Then store a rightventricular three-dimensional full volume image in a heart beat,and analysisthe image off-line.According to method above-mentioned put the leftventricular in the center of the screen,then store a right ventricularthree-dimensional full volume image in a heart beat,and analysis the imageoff-line.By analysis the image above-mentioned we acquired the volume-timecurves of right ventricular、left ventricular and some related parameters,suchas EDVRV、ESV_RV)、SV_RV、RVEF、EDVLV、SV_LV、SVLV、LVEF。Result:1Comparison of RV parameters RVAW、Tei index、PVR、PASP、RVEDV、RVESV、SV_RV all increase as RVEF reduces.In RVAW,there is no statistic difference between group A and group B except eachgroup.In terms of TEI index,there is statistic difference between each groupexcept control group and group A.Speaking of RVEDV,there is on statisticdifference between control group and group A、group B and group Cexcept each group. RVESV has significant difference between each groupexcept control group and group A.In terms of SV_RV,there is statistic difference between each group except control group and group A、group Band group C.Ea/Aa、 TAPSE all drop with the reducing of RVEF.InEa/Aa,there is statistic difference between each group except group B andgroup C.TAPASE has significant difference between each group exceptgroup B and group C.2Comparison of RA volume parameters VmaxI、VpreaI and VminI all increase as RVEF reduces.There is statistic differencebetween each group except control group and group A.RVI rise with thereducing of RVEF,while CVI decreases,CCVI first rises and the decreases.InRVI, group B and group Cis different from group B and group C.Speaking ofCVI,there is statistic difference between each group except group A andgroup B. In terms of CCVI, there is statistic difference between controlgroup and group A、B、C.3Correlation statistics: Correlation statisticsbetween RVEF and right atrium function RVEF is negatively related toRVI.RVEF is positively related to CVI.RVEF has a significant associationwith CVI.Correlation statistics between Ea/Aa and right atrium functionEa/Aa is negatively related to RVI、CCVI,Ea/Aa is positively related toCVI.Ea/Aa has a significant association with CVI. Correlation statisticsbetween CVI and right ventricular、pulmonary artery pressure CVI isnegatively related to PVR、PASA、Tei index,CVI is positively related toRVEF、 Ea/Aa、 RVAW. Correlation statistics between RVI and rightventricular、pulmonary artery pressure RVI is negatively related to RVEF、Ea/Aa,RVI is positively related to VmaxI、Tei index、PVR、PASP.4.Screeningmain factors influencing CVI,CVI as the dependent variable,RVAW、PASP、RVEF、Ea/Aa、PVR and Tei index as independent variables,by using multiplestepwise regression analysis, PVR、 Ea/Aa are variables entering theequation,R Square is0.796. Screening main factors influencing RVI,RVI asthe dependent variable,PVR、PASP、RVEF、Ea/Aa、VmaxI and Tei index asindependent variables,by using multiple stepwise regression analysis,VmaxI、PVR、PASP、RVEF are variables entering the equation,R Square is0.835.Conclusions:1.In patients with chronic pulmonary artery hypertension,the change of right atrium’ function is related with differentstate of right ventricular’ function.2.In patients with chronic pulmonaryartery hypertension, right atrium’"conduit"function is influenced mainly byright ventricular’ diastolic function,right atrium’"reservoir" function isinfluenced by right ventricular’ systolic function.3.Some index of rightventricular and pulmonary artery pressure have relation to right atrium’"reservoir" function and "conduit"function.And these index can be used toevaluate the mechanism of the change of right atrium’ function.