Pulmonary hypertension (PH) is a life-threatening condition. Right atrial (RA) dilatation is a prognostic parameter, however, the role of RA and LA function as assessed by speckle-tracking imaging remains unclear. The aim of our study was to assess in PH patients RA and LA function and its relationship with outcomes.

Sixty consecutive PH patients [group 1 (72%) and group 4] not eligible to either pulmonary endarterectomy or angioplasty were prospectively enrolled into this echocardiographic cohort study. In addition to clinical assessment, BNP and 6-minute walk test (6MWT), all patients underwent transthoracic echocardiography (TTE) for PH/RV and RA function assessment with 2D speckle-tracking RA longitudinal strain (LS) including reservoir (RArLS), contractile (RActLS) and conduit (RAcLS) phases analysis, LA LS as well as RA and LA volumes and areas. Patients’ mean age was 62.8±17.3 years and 57% were female. After a median follow-up of 16 months, 8 patients (13.3%) died. RArLS, RAcLS and RActLS were impaired in patients who died as compared to those who survived (respectively P=0.003, 0.06 and 0.02). On univariate analysis, BNP, RV end-diastolic diameter, pericardial effusion, mitral lateral E/e’, LVEF, TAPSE, LA volume, RA ejection fraction, RActLS, RArLS, RA volume and area were univariate predictors of death or transplant. After multivariable adjustment for age, NYHA class and univariate predictors of death, RA volume (HR=0.87; 95% CI: 0.78–0.96) and RArLS (HR=0.007; 95% CI: 0.78–0.96) were independent predictors of outcomes.

RA function is an important predictor of outcomes. RA volume and reservoir function appear as independent predictors of death in our cohort. The impairment of RA reservoir function likely represents an early indicator of RV failure, independent of RA dilatation.