Pulmonary embolism (PE) is a common life-threatening disease, with mortality related to right ventricular (RV) dysfunction. Right atrial (RA) dysfunction may be a new marker of PE severity. In this study, we aimed to assess RA function in patients with acute PE, as compared to a control population and to correlate RA function parameters to classic PE severity parameters.

We conducted a case-control study, including 27 consecutive PE patients, excluding high-risk PE patients. All patients underwent 2D transthoracic echocardiography with atrial function study within 6hours of PE diagnosis including RA longitudinal strain (LS) with reservoir (RArLS), conduit (RAcLS) and contractile (RActLS) phases. RA function was assessed using Autostrain LA (TomTec-Philips Medical System). A control group of 18 patients with no structural heart disease in sinus rhythm was recruited in the outpatient clinic. During acute PE, RA strain was impaired in PE patients as compared to controls: P<0.001 for RAcLS and P=0.01 for RArLS while no difference in RActLS was observed. When PE severity was graded from 1 to 3 (from intermediate-high to low risk), RAcLS and RArLS were significantly correlated to age and PE severity (Fig. 1).

Our RA strain study demonstrates an impaired RA reservoir and conduit function in PE patients, which seems to be related to PE severity. Further studies should help improve our understanding of RA dysfunction in PE.