Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

Abstract

Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e′ ratio (eRAPE/e′), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments.Methods and Results: eRAPIVC, eRAPE/e′, eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58–75) years, 49% males]. There was a positive correlation between eRAPmean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland–Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, eRAPE/e′, eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e′ and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAPmean than for eRAPIVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49–0.80 vs. 0.70, 95% CI 0.53–0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60–0.92 vs. 0.81, 95% CI 0.67–0.96; P = 0.43) thresholds.Conclusions: Our data suggest that multiparametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.

Comparison of subclavian vein to inferior vena cava collapsibility by ultrasound in acute heart failure: A pilot study

“…1 The American Society of Echocardiography supports the use of ultrasound assessment of IVC maximum diameter (IVC max ) and IVC collapsibility index (CI) with respiration to estimate right atrial pressure (RAP), 3,4 with recent validation. 5 IVC CI measurements have reasonable sensitivity (84%-96%) and specificity (37%-93%) for diagnosis of congestive heart failure, 6 and may help guide diuresis and heart failure therapy to improve patient outcomes. 7 The goal of volume management is to improve cardiac output by optimizing relative intravascular volume.…”

Hypovolemic Status in Older Hip Fracture Patients Elucidated by Preoperative Transthoracic Echocardiography

“…On the other hand, there was no significant difference in IVC diameter between the two groups. The IVC diameter reflects venous return and right atrial pressure [ 9 ], and the changes can be good indicators of fluid status, especially in a chronological comparison of the same case. However, the IVC diameter is affected by multiple comorbidities including congestive heart failure, valvular diseases, arrhythmias, and lung diseases [ 10 ]; hence, a comprehensive interpretation is essential along with other parameters and pathological conditions.…”

Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings

“…Other studies showed only moderate reproducibility [ 55 ] of hepatic vein Doppler to predict RAP, and recently, some authors failed to reproduce the proposed eRAP index in a cohort of patients who underwent RHC. They conclude that the multiparametric eRAP index does not provide an advantage over guidelines suggested for RAP assessment, despite being more complex and time consuming [ 56 ]. In the field of advanced heart failure, it is of paramount importance to stress that our tool is able to predict right heart chambers congestion only, on the other hands, there are several echocardiographic techniques to predict left ventricular end diastolic pressure, which is another important parameter to know how to correctly manage such advanced patients [ 1 ].…”