Detection of elevated right atrial pressure using a simple bedside ultrasound measure

Simon, Marc A.; Kliner, Dustin; Girod, John P.; Moguillansky, Diego; Villanueva, Flordeliza S.; Pacella, John J.

doi:10.1016/j.ahj.2010.01.004

Cited by 41 publications

(34 citation statements)

References 16 publications

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“…An accurate estimation of RAP is of paramount importance to obtain more reliable noninvasive evaluations of pulmonary pressures. The most frequently used technique for its estimation is the observation of the diameter and collapsibility of the inferior vena cava (1,2). By tissue Doppler (TD) imaging technique the recording of myocardial and annular velocities is possible.…”

Section: Introductionmentioning

confidence: 99%

The time interval between the onset of tricuspid E wave and annular Ea wave (TE-Ea) can predict right atrial pressure in patients with heart failure

Naderi¹,

Amin²,

Haghighi³

et al. 2014

Anadolu Kardiyol Derg

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Objective: There is conflicting data regarding the tricuspid annular velocities and their relation to right ventricular filling pressures. We aimed to assess if the time interval between the onset of tricuspid E wave and annular Ea wave has any correlation with right sided filling pressure in patients with heart failure. Methods: Thirty heart failure patients (left ventricular ejection fraction≤35%) were enrolled. Echocardiography was performed to obtain tricuspid inflow and tissue Doppler annular velocities just before a standard right heart catheterization. The right atrial pressure was obtained from right heart catheterization. The E/Ea [the ratio of peak velocity of early tricuspid inflow wave (E) to peak velocity of early diastolic wave of the lateral tricuspid annulus (Ea)] and the time intervals between the beginning of R wave of electrocardiogram and onset of E (TE) as well as between the beginning of R wave and onset of Et (T Ea ) were measured, T E-Ea was calculated as T E-TEa . Results: The mean right atrial pressure (RAP) was 8.8 (SD=4.7) mm Hg. The mean T E-Ea was + 8.61 milliseconds. There was no significant correlation between RAP and E/Ea (r=0.08, p>0.05) but the correlation between T E-Ea and RAP was significant (r=0.5, p=0.01). Conclusion: According to our results and in contrary to some prior studies, we showed for the first time that right side T E-Ea stands as a better surrogate of right atrial pressure than E/Ea in heart failure patients. This finding needs more accurate studies and could present T E-Ea as a feasible tool to look into hemodynamics of heart failure patients. (Anadolu Kardiyol Derg 2014; 14: 585-90)

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Section: Introductionmentioning

confidence: 99%

The time interval between the onset of tricuspid E wave and annular Ea wave (TE-Ea) can predict right atrial pressure in patients with heart failure

Naderi¹,

Amin²,

Haghighi³

et al. 2014

Anadolu Kardiyol Derg

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“…In our ADHF patient group, the cutoff value for CSA change was different than in our validation cohort based on the ROC curve data (Figure 2). 9 In the previous group, the majority of the patients studied were euvolemic, whereas the current patient group hospitalized was acutely decompensated. Consequently, the prevalence of disease (elevated central venous pressure) was different, and thus a different cut point on the ROC curve was obtained.…”

Section: Discussionmentioning

confidence: 95%

“…Invasive measurement by right heart catheterization is increasingly utilized in the management for heart failure patients and carries both safety and financial burdens. We previously demonstrated in patients undergoing right heart catheterization (n=67), that portable bedside ultrasound could be used to detect elevated RAP with a negative predictive value of 94% 9. This finding stems from the basic biomechanical properties of veins: At low pressure, venous compliance is high, and an increase in pressure, such as during Valsalva, would be expected to cause a large change in visualization of the vein's cross‐sectional area (CSA).…”

Section: Introductionmentioning

confidence: 99%

“…This finding stems from the basic biomechanical properties of veins: At low pressure, venous compliance is high, and an increase in pressure, such as during Valsalva, would be expected to cause a large change in visualization of the vein's cross‐sectional area (CSA). Conversely, at high venous pressure, compliance is low, and increases in pressure (Valsalva) would be expected to cause only small changes in CSA 9. Intraobserver and interobserver testing showed negligible variability with this method (Spearman correlation coefficients of 0.904 [ P <0.0001], with intraclass correlation of 0.8752 [κ=1], and 0.9662 [ P <0.0001], with intraclass correlation of 0.8779 [κ=0.9], respectively) 9.…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, at high venous pressure, compliance is low, and increases in pressure (Valsalva) would be expected to cause only small changes in CSA 9. Intraobserver and interobserver testing showed negligible variability with this method (Spearman correlation coefficients of 0.904 [ P <0.0001], with intraclass correlation of 0.8752 [κ=1], and 0.9662 [ P <0.0001], with intraclass correlation of 0.8779 [κ=0.9], respectively) 9. In this study, we aimed to determine whether estimation of RAP using the ultrasound measurement of RIJV CSA change with Valsalva correlates with hypervolemia in patients admitted with ADHF and could predict 30‐day rehospitalization.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Simon

Schnatz

Romeo

et al. 2018

JAHA

Self Cite

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BackgroundHeart failure is one of the most costly diagnosis‐related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross‐sectional area (CSA) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure.Methods and ResultsPatients admitted with acute decompensated heart failure (ADHF) underwent ultrasound measurements of the right internal jugular vein at end‐expiration and during the strain phase of Valsalva to determine a percentage of CSA change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of CSA change predictive of right atrial pressure (RAP) ≥12 mm Hg. Images of admitted ADHF patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a <66% CSA change predicted RAP ≥12 mm Hg (positive predictive value: 87%; P<0.05, receiver operating characteristic curve). Elevated admission RAP by percentage of CSA change normalized by discharge (P<0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the cutoff value of 66% CSA change, normal RAP at discharge had 91% predictive value for patients avoiding 30‐day readmission (P<0.05).ConclusionsThis bedside ultrasound technique strongly correlates to invasive RAP measurement in ADHF patients, identifies restoration of euvolemia, and is predictive of 30‐day ADHF readmission. This tool could help guide inpatient ADHF treatment and may lead to reduced readmissions.

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Ultrasound imaging of congestion in heart failure: examinations beyond the heart

Pellicori

Platz

Dauw

et al. 2020

European J of Heart Fail

112

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Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state‐of‐the‐art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B‐lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).

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Detection of elevated right atrial pressure using a simple bedside ultrasound measure

Cited by 41 publications

References 16 publications

The time interval between the onset of tricuspid E wave and annular Ea wave (TE-Ea) can predict right atrial pressure in patients with heart failure

The time interval between the onset of tricuspid E wave and annular Ea wave (TE-Ea) can predict right atrial pressure in patients with heart failure

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Ultrasound imaging of congestion in heart failure: examinations beyond the heart

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