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Objectives <p>Pulmonary hypertension-induced right ventricular (RV) overload can result in right atrial (RA) remodeling and tricuspid regurgitation (TR), which in turn affects RV function and negatively impacts patient prognosis. This study aimed to clarify the prognostic significance of RA function and TR in patients with chronic thromboembolic pulmonary hypertension (CTEPH).</p> Methods <p>For this retrospective analysis of 97 patients with CTEPH who underwent balloon pulmonary angioplasty (BPA), clinical, hemodynamic, and echocardiographic data were acquired before the first BPA and after the final BPA. The composite end point was hospitalization due to right heart failure and all-cause death.</p> Results <p>After BPA, patients experienced significant increases in RA reservoir strain (RASr, 26.7 ± 9.1% vs. 35.2 ± 11.3%, <i>P</i>&lt;.001) and conduit strain (15.0[9.6] % vs. 22.6[9.6] %, <i>P</i>&lt;.001), with no significant change in RA contraction strain. TR was significantly improved after BPA, decreasing from 49.5% to 22.7% in patients with significant TR (<i>P</i>&lt;.001). Over a mean follow-up of 24.7 ± 12.4 months, 22 patients met the composite end point. On multivariate Cox regression analysis, Right atrial reservoir strain (RASr) was independently associated with composite clinical outcomes(<i>P</i>=.012). Patients with post-BPA RASr ≥ 29.85% exhibited superior event-free survival compared to those with lower values.</p> Conclusion <p>Right atrial reservoir and conduit functions were impaired in CTEPH patients and showed significant improvement following BPA. Post-BPA RASr ≥ 29.85% demonstrated an independent association with long-term clinical outcomes. These findings support the inclusion of RA strain in postoperative assessments and long-term follow-up of CTEPH patients treated with BPA.</p> Clinical relevance statement <p>In this study, 2D-speckle tracking echocardiography can be used to better monitor right heart status of patients. To some extent, it can help clinicians to provide better treatment for patients and improve the quality of life of patients.</p>

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Characteristics and prognostic significance of right atrium remodeling and tricuspid regurgitation after balloon pulmonary angioplasty—application value of echocardiography

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月1日

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  • Yaning Ma,
  • Dichen Guo,
  • Jianfeng Wang,
  • Xinyuan Zhang,
  • Huimin Hu,
  • Yeqing Wang,
  • Yuanhua Yang,
  • Xiuzhang Lv,
  • Juanni Gong,
  • Yidan Li

摘要

Objectives

Pulmonary hypertension-induced right ventricular (RV) overload can result in right atrial (RA) remodeling and tricuspid regurgitation (TR), which in turn affects RV function and negatively impacts patient prognosis. This study aimed to clarify the prognostic significance of RA function and TR in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

For this retrospective analysis of 97 patients with CTEPH who underwent balloon pulmonary angioplasty (BPA), clinical, hemodynamic, and echocardiographic data were acquired before the first BPA and after the final BPA. The composite end point was hospitalization due to right heart failure and all-cause death.

Results

After BPA, patients experienced significant increases in RA reservoir strain (RASr, 26.7 ± 9.1% vs. 35.2 ± 11.3%, P<.001) and conduit strain (15.0[9.6] % vs. 22.6[9.6] %, P<.001), with no significant change in RA contraction strain. TR was significantly improved after BPA, decreasing from 49.5% to 22.7% in patients with significant TR (P<.001). Over a mean follow-up of 24.7 ± 12.4 months, 22 patients met the composite end point. On multivariate Cox regression analysis, Right atrial reservoir strain (RASr) was independently associated with composite clinical outcomes(P=.012). Patients with post-BPA RASr ≥ 29.85% exhibited superior event-free survival compared to those with lower values.

Conclusion

Right atrial reservoir and conduit functions were impaired in CTEPH patients and showed significant improvement following BPA. Post-BPA RASr ≥ 29.85% demonstrated an independent association with long-term clinical outcomes. These findings support the inclusion of RA strain in postoperative assessments and long-term follow-up of CTEPH patients treated with BPA.

Clinical relevance statement

In this study, 2D-speckle tracking echocardiography can be used to better monitor right heart status of patients. To some extent, it can help clinicians to provide better treatment for patients and improve the quality of life of patients.