Heart and Vessels

, Volume 34, Issue 3, pp 477–483 | Cite as

Echocardiographic surrogates of right atrial pressure in pulmonary hypertension

  • Ryo Watanabe
  • Hirohisa Amano
  • Fumiya Saito
  • Shigeru Toyoda
  • Masashi Sakuma
  • Shichiro Abe
  • Toshiaki Nakajima
  • Teruo InoueEmail author
Original Article


Right atrial pressure (RAP), a representative parameter of right heart failure, is very important for prognostic evaluation and risk assessment in pulmonary hypertension. However, its measurement requires invasive cardiac catheterization. In this study, we determined the most accurate echocardiographic surrogate of catheterization-based RAP. In 23 patients with pulmonary hypertension, a total of 66 cardiac catheterization procedures were performed along with 2-dimensional echocardiography. We evaluated tricuspid E/A, E', A' and E/E', and estimated RAP by the respirophasic variation of the inferior vena cava diameter (eRAP-IVCd) as possible surrogates of catheterization-based RAP. In simple linear regression analysis, E/A (R = 0.452, P = 0.0001) and eRAP-IVCd (R = 0.505, P < 0.0001) were positively correlated with catheterization-based RAP, whereas A' (R = − 0.512, P < 0.0001) was negatively correlated with RAP. In multiple regression analysis, A' was the most significant independent predictor of catheterization-based RAP (R = − 0.375, P = 0.0007). In 16 patients who had multiple measurements, there were a total of 43 measurements before and after medication changes. The absolute change in catheterization-based RAP was negatively correlated with the percent change in A'. Receiver operating characteristic curve analysis indicated that the optimal cut-off value of A' to predict a catheterization-based RAP > 10 mmHg was 11.3 cm/s (area under the curve = 0.782, sensitivity = 0.70, specificity = 0.78). In 20 measurements of 20 patients with left heart failure, catheterization-based RAP was not correlated with any of 5 echocardiographic parameters. However, it was closely correlated with catheterization-based pulmonary capillary wedge pressure. The echocardiographic parameter, A', was the best surrogate of catheterization-based RAP in patients with pulmonary hypertension.


Right atrial pressure Cardiac catheterization Echocardiography A' Pulmonary hypertension 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Ryo Watanabe
    • 1
  • Hirohisa Amano
    • 1
  • Fumiya Saito
    • 1
  • Shigeru Toyoda
    • 1
  • Masashi Sakuma
    • 1
  • Shichiro Abe
    • 1
  • Toshiaki Nakajima
    • 1
  • Teruo Inoue
    • 1
    Email author
  1. 1.The Department of Cardiovascular MedicineDokkyo Medical University School of MedicineMibu, TochigiJapan

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