Background
Right atrial (RA) imaging has emerged as a promising tool for the evaluation of patients
with pulmonary hypertension (PH), albeit without systematic validation.
Methods
PubMed, Web of Science and the Cochrane library were searched for studies investigating
the prognostic value of RA imaging assessment in patients with PH from 2000 to June
2021 (PROSPERO Identifier: CRD42020212850). An inverse variance-weighted meta-analysis
of univariable hazard ratios (HRs) was performed using a random effects model.
Results
Thirty-five studies were included (3,476 patients with PH; 74% female, 86% pulmonary
arterial hypertension). Risk of bias was low/moderate (Quality of Prognosis Studies
checklist). RA area (HR 1.06; 95% confidence interval [CI] 1.04-1.08), RA indexed
area (HR 1.09; 95% CI 1.04-1.14), RA peak longitudinal strain (PLS; HR 0.94; 95% CI
0.91-0.97) and RA total emptying fraction (HR 0.96; 95% CI 0.94-0.98) were significantly
associated with combined end-points including death, clinical worsening and/or lung
transplantation; RA volume and volume index showed marginal significant associations.
RA area (HR 1.06; 95% CI 1.04-1.07), RA indexed area (HR 1.12; 95% CI 1.07-1.17) and
RA PLS (HR 0.98; 95% CI 0.97-0.99) showed significant associations with mortality;
RA total emptying fraction showed a marginal association.
Conclusions
Imaging-based RA assessment qualifies as a relevant prognostic marker in PH. RA area
reliably predicts composite end-points and mortality, which underscores its clinical
utility. RA PLS emerged as a promising imaging measure, but is currently limited by
the number of studies and different acquisition methods.
Graphic abstract
Graphical Abstract
KEYWORDS
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Publication history
Published online: December 08, 2022
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