Right atrial function: still underestimated in clinical cardiology
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The study of Willens et al  in the current issue of the International Journal of Cardiac Imaging shows, that in a limited number of healthy subjects right atrial passive emptying volume and passive emptying fraction decreases with age and active emptying volume and active right atrial ejection fraction increase with age. This could indicate that with increasing age right ventricular diastolic function deceases irrespective of the occurrence of cardiac disease. In patients with pulmonary arterial hypertension right atrial function was even more impaired with larger right atrial maximal volume, minimal volume and volumes at the P-wave, lower passive right atrial emptying fraction and higher active right atrial emptying volume and active right atrial emptying fraction pulmonary artery systolic pressure correlated fairly with active emptying volume The study of Willens gives a nice insight in right atrial mechanics and volumes in healthy individuals and patients with pulmonary hypertension. We have to take in account, that this study has several limitations. First, it is a very small study with a very limited number of patients with pulmonary hypertension included. A more serious limitation is due to the sometimes poor acoustic window of ultrasound and therefore poor definition of the right atrial endocardium and the geometric assumptions, which have been made using single plane planimetry method of discs to calculate right atrial volumes and right atrial function. As indicated, measurement of right atrial function with 3D echo or with cardiac magnetic resonance imaging in a larger cohort of normal individuals and patients could make the results more valid. The results are not without any impact. In the next decades we will see a growing number of patients with right ventricular and right atrial dysfunction: Patients with chronic pulmonary diseases, after pulmonary embolism, after right ventricular infarction, chronic heart failure, valvular heart disease and atrial fibrillation. Especially in a population with a growing number of elderly people and diseases related to higher age as atrial fibrillation and pulmonary hypertension and right ventricular dysfunction right ventricular and right atrial function has to be determined more frequently. Thus proper treatment can be initiated more accurately and the effects of treatment on the right atrium and right ventricle can be evaluated. For this, 3D echocardiography and magnetic resonance imaging are the preferred imaging tools. If these techniques are not available reasonable evaluation of right atrial function can be done with 2D echocardiography.
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