Inaccuracy of Right Atrial Pressure Estimates Through Inferior Vena Cava Indices

https://doi.org/10.1016/j.amjcard.2017.07.069Get rights and content

The precision of echocardiography in estimating pulmonary pressures has been debated. A value of right atrial pressure (RAP) is needed for pulmonary pressure estimation, and it could be partly responsible for the estimation error. Several schemes based on the inferior vena cava (IVC) are commonly used in clinical practice and in experimental studies for RAP estimation. However, the majority lack proper validation, and thus far, no study has compared them all. In this prospective, blinded study, a comprehensive transthoracic echocardiography was performed on 200 patients referred for right heart catheterization. The IVC was measured in different views and RAP was estimated according to 6 different schemes. One hundred ninety patients were suitable for analysis. IVC measurements were significantly but poorly associated with invasive RAP. All RAP schemes showed poor accuracy compared with invasive RAP (average accuracy 34%). None of the schemes showed a clear superiority over the others. No echocardiographic or clinical variables showed a relevant impact on the estimation error. In conclusion, RAP estimation based on the IVC is highly inaccurate irrespective of the method used and should be avoided whenever possible. Whether adding estimated RAP values affects the estimation of pulmonary pressures is yet to be determined.

Section snippets

Methods

The Right Heart Invasive and Echocardiographic Hemodynamic Evaluation in Turin 1 (RIGHT1) study was a prospective, blinded study to compare the performance of several echocardiographic indices of pulmonary hemodynamics. Two hundred patients, referred to the Hemodynamic Laboratory of the AOU Citta' Salute e Scienza of Turin with a generic indication for right heart catheterization (RHC), were enrolled from July 2011 to November 2013. Exclusion criteria included ongoing infusions of

Results

Two hundred patients were enrolled in the study. Ten enrolled patients were excluded due to technical issues during catheterization, inconclusive catheterization results, or because echocardiography could not be performed. One hundred ninety patients were included in the data analyses. One hundred seven patients (83%) underwent RHC for diagnostic purposes, 27 (14%) for follow-up in a known pulmonary hypertension, and 6 (3%) for follow-up in cardiac transplantation. Echocardiography was

Discussion

RAP estimation is an essential step in obtaining an absolute value of pulmonary pressure using echocardiography. However, the reliability of echocardiography in evaluating pulmonary pressures has often been questioned, partially due to poor performances in RAP estimation.

The association between the IVC and RAP was observed for the first time in 197912 and was subsequently explored by other studies, producing conflicting results.13 IVC-based methods became the standard for RAP estimation both in

Disclosures

All authors have no conflicts of interest to disclose.

Acknowledgment

The authors thank Dr. LiQun Liu for her contribution to the editing of this article.

References (16)

There are more references available in the full text version of this article.

Cited by (53)

  • A Novel Method for Estimating Right Atrial Pressure With Point-of-Care Ultrasound

    2023, Journal of the American Society of Echocardiography
View all citing articles on Scopus

The Writing Committee Members for RIGHT1 Investigators include the following: Caterina Bucca, MD, Department of Clinical Physiopathology, University of Turin; Mara Morello, MD, Chair of Cardiology, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; Walter Grosso Marra, MD, Chair of Cardiology, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; Isabel Losano, MD, Internal and Hypertension Division, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; and Agnese Ravera, MD, Internal and Hypertension Division, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin.

Funding sources: None.

See page 1672 for disclosure information.

View full text