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Right atrial function with speckle tracking echocardiography: Do we really need it?
Função da aurícula direita com ecocardiografia de speckle tracking: precisamos realmente desse processo?
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A three-dimensional wireframe reconstruction of the left atrium based on three-dimensional speckle-tracking echocardiographic analysis together with volumetric data and segmental (circumferential) time-strain curves are also presented. White, dashed and yellow arrows represent segmental (systolic) peak strain, (late-diastolic) strain at atrial contraction and global time-volume curve, respectively. LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Dóra Földeák, Árpád Kormányos, Péter Domsik, Anita Kalapos, Györgyike Á. 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411734 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Right atrial longitudinal strain imaging.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Onder Ozturk, Unal Ozturk, Sengul Ozturk" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Onder" "apellidos" => "Ozturk" ] 1 => array:2 [ "nombre" => "Unal" "apellidos" => "Ozturk" ] 2 => array:2 [ "nombre" => "Sengul" "apellidos" => "Ozturk" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303781?idApp=UINPBA00004E" "url" => "/21742049/0000003600000012/v1_201712220644/S2174204917303781/v1_201712220644/en/main.assets" ] ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Right atrial function with speckle tracking echocardiography: Do we really need it?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "901" "paginaFinal" => "904" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lígia Mendes, Nuno Cardim" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Lígia" "apellidos" => "Mendes" "email" => array:1 [ 0 => "ligia.mendes@hospitaldaluz.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nuno" "apellidos" => "Cardim" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology, Hospital da Luz, Setúbal, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiac Multimodality Imaging Department, Hospital da Luz, Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Função da aurícula direita com ecocardiografia de <span class="elsevierStyleItalic">speckle tracking</span>: precisamos realmente desse processo?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1528 "Ancho" => 2333 "Tamanyo" => 183155 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Interaction between right atrium strain and right ventricle strain. The white arrows indicate the strength of myocardial contraction and the crimson arrows indicates passive movement of right atrium.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atrial septal defect (ASD) is one of the most common congenital cardiac anomalies presenting in adulthood. ASD is characterized by a defect in the interatrial septum that allows pulmonary venous return from the left atrium to pass directly to the right atrium. The magnitude of the left-to-right shunt across the ASD depends on the defect size, the relative compliance of the ventricles, and the relative resistance of both the pulmonary and the systemic circulation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The three major types of atrial septal defect (ostium secundum, ostium primum and sinus venosus) account for 10% of all congenital heart defects and as much as 20-40% of congenital heart disease presenting in adulthood.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In general, elective closure is recommended for all ASDs with evidence of right ventricular (RV) overload or with a clinically significant shunt (pulmonary flow [Qp] to systemic flow [Qs] ratio >1.5). Lack of symptoms is not a contraindication for repair.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> At any age, ASD closure is followed by symptomatic improvement and regression of RV size.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Ostium secundum ASD may be closed with a variety of catheter-implanted occlusion devices rather than by direct surgical closure with cardiopulmonary bypass.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> Compared with surgery, transcatheter closure appears to have additional benefits, including hemodynamic improvement and preservation of atrial function.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although myocardial mechanics has been primarily used to study left ventricular (LV) performance, since 2007 it has also been applied to the assessment of thin-walled structures such as the left atrium.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> Subsequently, analysis of right atrial (RA) mechanics using two-dimensional (2D) speckle tracking echocardiography (STE) also proved feasible,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6–12</span></a> and normal reference values have been published.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Throughout the phases of the cardiac cycle, the right atrium serves three distinct functions (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Reservoir phase: storage of blood arriving from the systemic venous circuit during ventricular systole;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall">Conduit phase: passive filling of blood from the inferior and superior venae cavae to the right ventricle during early and mid diastole;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Booster pump phase: contributing to RV filling in late diastole by atrial contraction.</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The reservoir and conduit phases are often termed passive phases, whereas the atrial contraction phase is considered the active phase. All phases are modulated by loading conditions, heart rate and the intrinsic contractility of the atria.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Right atrial peak strain derived from 2D-STE has been proved to be a reliable tool to study RA performance.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> Peak atrial strain (the peak of the positive deflection occurring during the reservoir phase, when the right ventricle contracts and the right atrium fills against a closed tricuspid valve) is perhaps the most used parameter of RA function. It depends on:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Long-axis ventricular contraction<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> – higher longitudinal RV strain results in greater tricuspid annular plane systolic excursion (TAPSE) during systole and therefore higher RA strain (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>);</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">RA compliance<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> – less compliant atria have lower strain;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">RA volume<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> – for the same amount of blood received, dilated atria have lower peak atrial strain than non-dilated atria (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">In accordance with the above, since a chronic significant left-to-right shunt through an ASD leads to a varying degree of RA dilatation due to volume overload, peak atrial strain should be decreased in ASD patients, who have dilated atria. However, in the absence of pulmonary hypertension, it should be increased, due to high TAPSE in the presence of increased preload.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Ozturk et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> show that 2D-STE-derived RA peak strain is decreased in ASD patients and increases after ASD closure – a similar result to those of another group<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> who used a different methodology (strain derived from tissue Doppler imaging) to demonstrate low peak RA strain before ASD closure.</p><p id="par0085" class="elsevierStylePara elsevierViewall">As pointed out above, RA strain partially depends on RV systolic function and on TAPSE; so as expected, in the study by Ozturk et al.,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> as TAPSE was low, RA peak strain was also low before closure, and both increased after the procedure.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Why was TAPSE decreased before ASD closure, in the presence of a significant ASD with volume overload? The answer probably lies in the high pulmonary artery systolic pressure (PASP) found in Ozturk et al.’s study<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> (mean PASP 51.4±16.3 mmHg), which decreases RV systolic performance (as shown by TAPSE) and consequently RA peak strain. In fact, in a previous study by Jategaonkar et al.,<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> also with ASD patients but without pulmonary hypertension (mean PASP 19.9±5.2 mmHg), both TAPSE and RV strain decreased after ASD closure.</p><p id="par0095" class="elsevierStylePara elsevierViewall">To conclude, do we really need peak RA strain, it is methodologically complex and difficult to interpretation, when there are simpler and more reproducible measures such as TAPSE (or RV strain)? And do we really need to study the atria with 2D-STE, a cutting-edge technique with great potential in different clinical scenarios, but posing demanding technical challenges for RA assessment (thin walls, difficulty in contouring, many structures fitted into a tight compartment, unusual chamber geometry and poor definition due to its anterior position, and lack of commercially available software specific to the right atrium)?</p><p id="par0100" class="elsevierStylePara elsevierViewall">Let the future clarify our souls.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1122 "Ancho" => 1585 "Tamanyo" => 91999 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Longitudinal Strain Curve during the different phases of the cardiac cycle.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1528 "Ancho" => 2333 "Tamanyo" => 183155 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Interaction between right atrium strain and right ventricle strain. The white arrows indicate the strength of myocardial contraction and the crimson arrows indicates passive movement of right atrium.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1277 "Ancho" => 2317 "Tamanyo" => 135161 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Interaction between right atrium size and strain.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC); Association for European Paediatric Cardiology (AEPC); ESC Committee for Practice Guidelines (CPG)" "etal" => true "autores" => array:3 [ 0 => "H. 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| Year/Month | Html | Total | |
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| 2020 January | 48 | 11 | 59 |
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| 2019 October | 49 | 9 | 58 |
| 2019 September | 73 | 13 | 86 |
| 2019 August | 30 | 6 | 36 |
| 2019 July | 41 | 10 | 51 |
| 2019 June | 48 | 11 | 59 |
| 2019 May | 30 | 14 | 44 |
| 2019 April | 27 | 16 | 43 |
| 2019 March | 68 | 15 | 83 |
| 2019 February | 90 | 15 | 105 |
| 2019 January | 88 | 6 | 94 |
| 2018 December | 97 | 12 | 109 |
| 2018 November | 76 | 16 | 92 |
| 2018 October | 32 | 11 | 43 |
| 2018 September | 36 | 14 | 50 |
| 2018 August | 30 | 7 | 37 |
| 2018 July | 31 | 4 | 35 |
| 2018 June | 45 | 7 | 52 |
| 2018 May | 26 | 5 | 31 |
| 2018 April | 28 | 4 | 32 |
| 2018 March | 52 | 14 | 66 |
| 2018 February | 42 | 18 | 60 |
| 2018 January | 36 | 20 | 56 |
| 2017 December | 21 | 8 | 29 |
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