Estimation of Right Atrial Pressure on Inferior Vena Cava Ultrasound in Asian Patients

Abstract

Background: Right atrial pressure (RAP) is commonly estimated using inferior vena cava (IVC) diameter and its respirophasic variations. Although a guideline has been provided for estimation of RAP due to variation in IVC dimensions based on studies in Western subjects, echocardiographic values in Asian subjects are unknown. Methods and Results:We studied 369 patients who underwent IVC ultrasound within 24 h of right heart catheterization (RHC). The maximum and minimum IVC diameter during a respiratory cycle and the percent collapse after a sniff test were measured. These IVC parameters were compared with mean RAP measured on RHC. Receiver operating characteristic curves were generated for each IVC parameter to determine the optimal cut-off to detect RAP >10 mmHg. The IVC maximum diameter cut-off for detecting RAP >10 mmHg was 19 mm (sensitivity, 75%; specificity, 78%) and the percent collapse cut-off was 30% (sensitivity, 75%; specificity, 83%). Both cut-offs were smaller than those previously reported in patients from Western countries. When the cut-off values from the existing guideline were applied to the present cohort, the sensitivity and specificity for normal RAP (0-5 mmHg) were 38.6% and 74.2%, respectively, and 60.0% and 92.0% for elevated RAP (>10 mmHg). Conclusions:The optimal IVC maximum diameter and percent collapse cut-offs to detect elevated RAP were smaller in Asian subjects than in a previously reported Western cohort. (Circ J 2014; 78: 962 -966)

Reconsideration of Inferior Vena Cava Parameters for Estimating Right Atrial Pressure in an East Asian Population ― Comparative Simultaneous Ultrasound-Catheterization Study ―

“…Although catheterization was performed within 24 h of IVC ultrasound, interpretation of the IVC parameters for RAP was limited. 12 Furthermore, a previous study, 8 as well as our study, 12 included patients with heart transplantation, and increased stiffness of the IVC at the join between the donor and recipient might have affected the IVC values or their respiratory variation. 13 In the present study, we compared the invasive RAP value with IVC parameters that were obtained simultaneously and analyzed the optimal IVC parameter cut-off values to predict elevated RAP in a relatively large East Asian cohort.…”

“…From our ROC curve, a cut-off value of 21 mm had a sensitivity of 50% and specificity of 97% (Figure 3), and this sensitivity was very low, as we had previously published. 12 A new classification scheme may be required based on these results. However, it must be recognized that our population was East Asian, because we encounter mainly East Asian patients in our daily practice.…”

“…Recently, we reported that the cut-off values of IVC parameters to predict elevated RAP might be less than 21 mm and 50% in an Asian population. 12 However, the major limitation of that study was that ultrasound and invasive measurement were not performed simultaneously. Although catheterization was performed within 24 h of IVC ultrasound, interpretation of the IVC parameters for RAP was limited.…”

Inferior vena cava guided fluid resuscitation – Fact or fiction?

“…Lee et al 33 reported that the IVC parameters used to detect elevated RAP were significantly smaller in their cohort of 369 Asian patients, compared to a previously reported Western cohort. This is likely due to the generally smaller Asian physique.…”

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

“…An IVC max diameter 1.9 cm was found to be the optimal cutoff to predict an elevated right atrial pressure >10 mm Hg in a study of Japanese cardiac patients with a relatively lower body mass index. 39 Another limitation is the timing of the admission IVC measurement within the first 24 hours of arrival to the hospital rather than immediately upon arrival to the emergency department. We were not able to control for interventions given in the emergency department prior to the measurement of the admission IVC, including doses of diuretics.…”