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European Journal of Heart Failure 2009 11(12):1169-1177; doi:10.1093/eurjhf/hfp158
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Right atrial size and deformation in patients with dilated cardiomyopathy undergoing cardiac resynchronization therapy

Antonello D'Andrea1,*, Raffaella Scarafile1, Lucia Riegler1, Gemma Salerno1, Rita Gravino1, Rosangela Cocchia1, Francesca Castaldo1, Filomena Allocca1, Giuseppe Limongelli1, Giovanni Di Salvo1, Sergio Cuomo1, Giuseppe Pacileo1, Pio Caso2, Maria Giovanna Russo1 and Raffaele Calabrò1

1 Department of Cardiology, Second University of Naples, Via G. Martucci 35, Naples 80121, Italy
2 Department of Cardiology, Monaldi Hospital, Naples, Italy

* Corresponding author. Tel: +39 081 761 8525, Fax: +39 081 714 5205, Email: antonellodandrea{at}libero.it


  Abstract

Aims: To evaluate right atrial (RA) morphology and deformation in patients with dilated cardiomyopathy (DCM).

Methods and results: A total of 130 patients with either idiopathic (n = 70) or ischaemic (n = 60) DCM, and 60 controls underwent clinical examination, standard echocardiography, and RA two-dimensional strain echocardiography (2DSE). Six months after implantation of a cardiac resynchronization therapy (CRT) device, the DCM patients were re-evaluated, if their left ventricular (LV) end-systolic volume had decreased by at least 15% they were defined as echocardiographic responders. All DCM patients were in NYHA class III before CRT, with a mean LV ejection fraction of 29.2 ± 5.5%. After CRT, 94 patients were in NYHA functional class I–II. The patients were subdivided into echocardiographic responders (n = 85) and non-responders (n = 45). Both RA area index (19.7 ± 5.5 cm2/m in non-responders vs. 13.2 ± 4.4 cm2/m in responders; P < 0.001) and RA strain of lateral wall (24.3 ± 10.2% in non-responders vs. 40.2 ± 8.9% in responders; P < 0.001) were significantly different between the two groups. A RA area index ≥16 cm2/m showed a sensitivity and specificity of 87.1 and 95.4%, respectively (P < 0.0001) to predict a negative response to CRT. By multivariable analysis, increased RA area index (P < 0.001), ischaemic aetiology of DCM (P < 0.01), and less severe radial intraventricular dyssynchrony were independent determinants of an unfavourable response to CRT.

Conclusion: Right atrial area index was increased and RA myocardial deformation was impaired in patients with DCM who were non-responders to CRT.

Key Words: Heart failure • Cardiac resynchronization therapy • Two-dimensional strain imaging • Right atrium • Right atrial size

Received May 14, 2009; Revised September 7, 2009; Accepted September 22, 2009


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