TY - JOUR
T1 - Precision of echocardiographic estimates of right atrial pressure in patients with acute decompensated heart failure
AU - Tsutsui, Rayji S.
AU - Borowski, Allen
AU - Tang, W. H Wilson
AU - Thomas, James D.
AU - Popović, Zoran B.
N1 - Publisher Copyright:
© 2014 by the American Society of Echocardiography.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background Several methods that estimate right atrial pressure (RAP) from echocardiographic parameters have been proposed. However, their precision (i.e., how much they decrease RAP estimation uncertainty) is unknown. The aim of this prospective study was to evaluate and compare the precision of previously proposed RAP estimates in patients with acute decompensated heart failure.Methods Echocardiographic and invasive hemodynamic data were acquired in 75 patients with acute decompensated heart failure. Measurements were made at the start and 48 to 72 hours after the beginning of treatment. RAP was estimated by method 1, using the cutoffs defined by inferior vena cava diameter (IVCd) and IVCd percentage change (IVCd%change) during inspiration, and by method 2, using IVCd%change and systolic to diastolic hepatic flow ratio (S/Dhep). Method 3 was used in patients with sinus rhythm, using the ratio of early tricuspid inflow and early diastolic tissue Doppler tricuspid annular velocities (E/E′ta). RAP was also estimated by resting IVCd, IVCd during inspiration, IVCd%change, right ventricular regional isovolumetric relaxation time, E/E′ta, right atrial volume index, S/Dhep, right ventricular Tei index, right ventricular E/A, and right atrial emptying fraction. Precision gain was measured as the difference between the standard deviation of RAP and the standard error of the estimate of RAP.Results Method 1 (r = 0.48, P <.05), IVCd during inspiration (r = 0.49, P <.0001), IVCd%change (r = 0.41, P <.0001) and IVCd (r = 0.40, P <.0001) had the highest correlation with RAP. The highest gain in precision was also observed with the above methods (9%, 13%, 9%, and 8%, respectively). All other parameters had poor correlation with RAP. Conclusion In patients with advanced heart failure, echocardiographic RAP prediction methods showed only modest precision. Furthermore, none of the tested methods resulted in clinically relevant improvements of RAP estimates. Estimating RAP from a single IVCd measurement is at least as precise as using complex prediction methods.
AB - Background Several methods that estimate right atrial pressure (RAP) from echocardiographic parameters have been proposed. However, their precision (i.e., how much they decrease RAP estimation uncertainty) is unknown. The aim of this prospective study was to evaluate and compare the precision of previously proposed RAP estimates in patients with acute decompensated heart failure.Methods Echocardiographic and invasive hemodynamic data were acquired in 75 patients with acute decompensated heart failure. Measurements were made at the start and 48 to 72 hours after the beginning of treatment. RAP was estimated by method 1, using the cutoffs defined by inferior vena cava diameter (IVCd) and IVCd percentage change (IVCd%change) during inspiration, and by method 2, using IVCd%change and systolic to diastolic hepatic flow ratio (S/Dhep). Method 3 was used in patients with sinus rhythm, using the ratio of early tricuspid inflow and early diastolic tissue Doppler tricuspid annular velocities (E/E′ta). RAP was also estimated by resting IVCd, IVCd during inspiration, IVCd%change, right ventricular regional isovolumetric relaxation time, E/E′ta, right atrial volume index, S/Dhep, right ventricular Tei index, right ventricular E/A, and right atrial emptying fraction. Precision gain was measured as the difference between the standard deviation of RAP and the standard error of the estimate of RAP.Results Method 1 (r = 0.48, P <.05), IVCd during inspiration (r = 0.49, P <.0001), IVCd%change (r = 0.41, P <.0001) and IVCd (r = 0.40, P <.0001) had the highest correlation with RAP. The highest gain in precision was also observed with the above methods (9%, 13%, 9%, and 8%, respectively). All other parameters had poor correlation with RAP. Conclusion In patients with advanced heart failure, echocardiographic RAP prediction methods showed only modest precision. Furthermore, none of the tested methods resulted in clinically relevant improvements of RAP estimates. Estimating RAP from a single IVCd measurement is at least as precise as using complex prediction methods.
KW - CVP
KW - Central venous pressure
KW - Inferior vena cava diameter
KW - Right atrial pressure
KW - Right atrial pressure estimation
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U2 - 10.1016/j.echo.2014.06.002
DO - 10.1016/j.echo.2014.06.002
M3 - Article
C2 - 25022574
AN - SCOPUS:84907613815
SN - 0894-7317
VL - 27
SP - 1072-1078.e2
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 10
ER -
