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.

Imaging the right atrium in pulmonary hypertension. a systematic review and meta-analysis / Richter, Manuel J; Fortuni, Federico; Alenezi, Fawaz; D'Alto, Michele; Badagliacca, Roberto; Brunner, Nathan W; van Dijk, Arie P; Douschan, Philipp; Gall, Henning; Ghio, Stefano; Giudice, Francesco Lo; Grünig, Ekkehard; Haddad, Francois; Howard, Luke; Rajagopal, Sudarshan; Stens, Niels; Stolfo, Davide; Thijssen, Dick H J; Vizza, Carmine Dario; Zamanian, Roham T; Zhong, Liang; Seeger, Werner; Ghofrani, Hossein A; Tello, Khodr. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - 42:4(2023), pp. 433-446. [10.1016/j.healun.2022.11.007]

Imaging the right atrium in pulmonary hypertension. a systematic review and meta-analysis

Badagliacca, Roberto;Vizza, Carmine Dario;
2023

Abstract

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.
2023
imaging; meta-analysis; outcome; pulmonary hypertension; right atrium; systematic review
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Imaging the right atrium in pulmonary hypertension. a systematic review and meta-analysis / Richter, Manuel J; Fortuni, Federico; Alenezi, Fawaz; D'Alto, Michele; Badagliacca, Roberto; Brunner, Nathan W; van Dijk, Arie P; Douschan, Philipp; Gall, Henning; Ghio, Stefano; Giudice, Francesco Lo; Grünig, Ekkehard; Haddad, Francois; Howard, Luke; Rajagopal, Sudarshan; Stens, Niels; Stolfo, Davide; Thijssen, Dick H J; Vizza, Carmine Dario; Zamanian, Roham T; Zhong, Liang; Seeger, Werner; Ghofrani, Hossein A; Tello, Khodr. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - 42:4(2023), pp. 433-446. [10.1016/j.healun.2022.11.007]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1671293
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