Right Atrial Pressure Is Associated with Outcomes in Patients with Heart Failure and Indeterminate Left Ventricular Filling Pressure

Mele, Donato; Pestelli, Gabriele; Molin, Davide Dal; Smarrazzo, Vittorio; Luisi, Giovanni Andrea; Trevisan, Filippo; Fiorencis, Andrea; Flamigni, Filippo; Ferrari, Roberto

doi:10.1016/j.echo.2020.05.027

Cited by 11 publications

(10 citation statements)

References 19 publications

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“…Moreover, a better stratification capability of SVI was observed in a study that compared the usefulness of SVI and stroke distance as prognostic markers 16 . These data support the use of SVI as the mainstream output measure to be integrated in echocardiographic assessment of heart failure patients 4,30‐32 …”

Section: Discussionmentioning

confidence: 60%

Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic stenosis severity assessment

et al. 2021

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Background Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA‐based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity. Methods A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N = 340), independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N = 200) and compared with the BSA‐derived formula. Results LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta = 0.392, P < .001), BSA (beta = 0.229, P < .001), LV end‐diastolic diameter (LVEDD, beta = 0.145, P = .001), and height (beta = 0.125, P = .037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD = 6.209 + [0.201 × SVD] + [1.802 × BSA] + [0.03 × LVEDD] + [0.025 × Height]) did not differ from (P = .937) and was highly correlated with measured LVOTD (R = 0.739, P < .001) in the validation group. Repeated analysis with LV end‐diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA‐derived LVOTD values were different from measured LVOTD (P < .001). Conclusion Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS when direct LVOTD measurement is difficult or impossible.

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Section: Discussionmentioning

confidence: 60%

Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic stenosis severity assessment

et al. 2021

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“…1,4 RHC is the gold standard for the assessment of RAP, and it is frequently used for risk stratification in patients with acquired heart disease and to determine optimal management strategy especially in patients with clinical or hemodynamic deterioration. 18,19 RHC is invasive and expensive, and, hence, has limited application in clinically stable and ambulatory patients.…”

Section: Discussionmentioning

confidence: 99%

Role of Inferior Vena Cava Dynamics for Estimating Right Atrial Pressure in Congenital Heart Disease

Egbe

Connolly

Pellikka

et al. 2022

Circ: Cardiovascular Imaging

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Background: Inferior vena cava (IVC) size and collapsibility (IVC dynamics) are used for estimating right atrial pressure (RAP). However, the diagnostic performance of the American Society of Echocardiography IVC criteria for estimating RAP in patients with congenital heart disease are unknown. The purpose of this study was to assess the role of IVC dynamics for estimating RAP in adults with congenital heart disease. Methods: We conducted a retrospective study of adults with congenital heart disease that underwent cardiac catheterization and echocardiogram at Mayo Clinic (2003–2019). IVC diameter was measured at inspiration (IVC min ) and end-expiration (IVC max ), and IVC collapsibility index (IVC CI ) was calculated. Results: Based on 918 patients, we observed a good correlation between IVC max and invasive RAP ( r =0.56, P <0.001); IVC min and RAP ( r =0.58, P <0.001); and IVC CI ( r =−0.72, P <0.001). There was excellent correlation between invasive RAP and estimated RAP using IVC CI ( r =0.80, P <0.001). We observed that IVC CI <60% had superior diagnostic performance as compared with American Society of Echocardiography criteria (IVC max >2.1 cm, area under the curve difference 0.15, P <0.001; IVC CI <50%, area under the curve difference 0.09, P =0.008; combination of IVC max >2.1 cm; and IVC CI <50%, area under the curve difference 0.06, P =0.02). Estimated RAP >10 mm Hg based on IVC CI had comparable prognostic performance as invasive RAP but superior prognostic performance as the American Society of Echocardiography criteria. Conclusions: IVC CI <60% was the best criterion to identify patients with elevated RAP. IVC CI was comparable to invasively measured RAP in its relation to prognosis. Further studies are required to determine whether the use of IVC CI in clinical decision-making will improve clinical outcomes in this population.

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“…One of the highest imprecisions in the prediction of hemodynamic measures by echocardiography is observed in the assessment of right atrial pressure (RAP) [ 17 , 18 , 19 , 20 ]. The knowledge of RAP is clinically relevant, since it may help to stratify prognosis in both patients with heart failure [ 21 , 22 ] and pulmonary hypertension [ 8 , 23 ], and it is vital to optimize fluid management (loading and unloading) in several clinical scenarios [ 24 ]. RAP is currently calculated by measuring inferior vena cava (IVC) dimension and collapsibility during respiration (indicated as caval index or collapsibility index) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Estimation of Right Atrial Pressure Using a Semi-Automated Echocardiographic Tool for Inferior Vena Cava Edge-Tracking

Mesin

Policastro

Albani³

et al. 2022

JCM

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The non-invasive estimation of right atrial pressure (RAP) would be a key advancement in several clinical scenarios, in which the knowledge of central venous filling pressure is vital for patients’ management. The echocardiographic estimation of RAP proposed by Guidelines, based on inferior vena cava (IVC) size and respirophasic collapsibility, is exposed to operator and patient dependent variability. We propose novel methods, based on semi-automated edge-tracking of IVC size and cardiac collapsibility (cardiac caval index—CCI), tested in a monocentric retrospective cohort of patients undergoing echocardiography and right heart catheterization (RHC) within 24 h in condition of clinical and therapeutic stability (170 patients, age 64 ± 14, male 45%, with pulmonary arterial hypertension, heart failure, valvular heart disease, dyspnea, or other pathologies). IVC size and CCI were integrated with other standard echocardiographic features, selected by backward feature selection and included in a linear model (LM) and a support vector machine (SVM), which were cross-validated. Three RAP classes (low < 5 mmHg, intermediate 5–10 mmHg and high > 10 mmHg) were generated and RHC values used as comparator. LM and SVM showed a higher accuracy than Guidelines (63%, 71%, and 61% for LM, SVM, and Guidelines, respectively), promoting the integration of IVC and echocardiographic features for an improved non-invasive estimation of RAP.

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Right Atrial Pressure Is Associated with Outcomes in Patients with Heart Failure and Indeterminate Left Ventricular Filling Pressure

Cited by 11 publications

References 19 publications

Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic stenosis severity assessment

Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic stenosis severity assessment

Role of Inferior Vena Cava Dynamics for Estimating Right Atrial Pressure in Congenital Heart Disease

Non-Invasive Estimation of Right Atrial Pressure Using a Semi-Automated Echocardiographic Tool for Inferior Vena Cava Edge-Tracking

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