PT  - JOURNAL ARTICLE
AU  - Markus H. Lerchbaumer
AU  - Matthias Ebner
AU  - Christian O. Ritter
AU  - Laura Steimke
AU  - Nina I.J. Rogge
AU  - Carmen Sentler
AU  - Aaron Thielmann
AU  - Lukas Hobohm
AU  - Karsten Keller
AU  - Joachim Lotz
AU  - Gerd Hasenfuß
AU  - Rolf Wachter
AU  - Bernd Hamm
AU  - Stavros V. Konstantinides
AU  - Galit Aviram
AU  - Mareike Lankeit
TI  - Prognostic value of right atrial dilation in patients with pulmonary embolism
AID  - 10.1183/23120541.00414-2020
DP  - 2021 Apr 01
TA  - ERJ Open Research
PG  - 00414-2020
VI  - 7
IP  - 2
4099  - http://openres.ersjournals.com/content/7/2/00414-2020.short
4100  - http://openres.ersjournals.com/content/7/2/00414-2020.full
SO  - erjor2021 Apr 01; 7
AB  - Aims Right atrial (RA) dilation and stretch provide prognostic information in patients with cardiovascular diseases. We investigated the prevalence, confounding factors and prognostic relevance of RA dilation in patients with pulmonary embolism (PE).Methods Overall, 609 PE patients were consecutively included in a prospective single-centre registry between September 2008 and August 2017. Volumetric measurements of heart chambers were performed on routine non-electrocardiographic-gated computed tomography and plasma concentrations of mid-regional pro-atrial natriuretic peptide (MR-proANP) measured on admission. An in-hospital adverse outcome was defined as PE-related death, cardiopulmonary resuscitation, mechanical ventilation or catecholamine administration.Results Patients with an adverse outcome (11.2%) had larger RA volumes (median 120 (interquartile range 84–152) versus 102 (78–134) mL; p=0.013), RA/left atrial (LA) volume ratios (1.7 (1.2–2.4) versus 1.3 (1.1–1.7); p<0.001) and MR-proANP levels (282 (157–481) versus 129 (64–238) pmol·L−1; p<0.001) compared to patients with a favourable outcome. Overall, 499 patients (81.9%) had a RA/LA volume ratio ≥1.0 and a calculated cut-off value of 1.8 (area under the curve 0.64, 95% CI 0.56–0.71) predicted an adverse outcome, both in unselected (OR 3.1, 95% CI 1.9–5.2) and normotensive patients (OR 2.7, 95% CI 1.3–5.6). MR-proANP ≥120 pmol·L−1 was identified as an independent predictor of an adverse outcome, both in unselected (OR 4.6, 95% CI 2.3–9.3) and normotensive patients (OR 5.1, 95% CI 1.5–17.6).Conclusions RA dilation is a frequent finding in patients with PE. However, the prognostic performance of RA dilation appears inferior compared to established risk stratification markers. MR-proANP predicted an in-hospital adverse outcome, both in unselected and normotensive PE patients, integrating different prognostic relevant information from comorbidities.RA dilation is a frequent finding but its prognostic performance appears inferior compared to other risk stratification markers. MR-proANP predicts an adverse outcome but elevation does not appear to be caused by RA dilation in a relevant proportion. https://bit.ly/3q55dqy