Echocardiographic RV-E/e′ for predicting right atrial pressure: a review

Abstract

Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e’ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e’ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operator characteristic analyses showed reasonable diagnostic ability of RV-E/e’ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e’ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland-Altman analyses showed good accuracy but poor precision of RV-E/e’ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e’ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e’, nor about the independent prognostic ability of RV-E/e’ . Recommended areas for future research concerning RV-E/e’ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.

Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

“…We also found that there was no significant difference in the PVPR between patients with HF in sinus rhythm and patients with AF. This indicated that there was no correlation between AF and high RAP, which is in agreement with the findings of a previous study[ 14 ].…”

Feasibility study on evaluating right ventricular diastolic function by new Tei’-Index

“…With respect to the assessment of right ventricular diastolic function, there is no widely accepted gold standard. Tricuspid valve E/A ratio, E/e’ ratio and DT (E wave decelerate time) are the parameters most commonly used for the assessment of RV diastolic function and the tricuspid E/A ratio, E/e’ ratio has been shown to correlate well with cardiovascular outcome and thus have immense clinical relevance [ 9 , 10 , 22 , 23 ]. In the multivariate regression analysis, it was found that the Tei’- index showed a significant correlation with the E/e 'and DT, which representing the early diastolic function, indicating that the new index was more effective in evaluating RV early diastolic dysfunction.…”

Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice

“…The results showed a reasonable diagnostic ability of RV-E/e′ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction [34] , [37] , [38] , [39] . The diagnostic ability of RV-E/e′ was generally poor in studies of pediatrics, heart failure and mitral stenosis [35] , [36] , [40] , while the results were equivocal in other diseases [41] . Bland–Altman analyses showed good accuracy but poor precision of RV-E/e′ for estimating RAP [34] , [36] .…”