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Association with right atrial strain with right atrial pressure: an invasive validation study

  • Leah M. Wright
  • Nathan Dwyer
  • Sudhir Wahi
  • Thomas H. Marwick
Original Paper
  • 66 Downloads

Abstract

Echocardiographic assessment of right atrial pressure (RAP) from inferior vena cava (RAPIVC) dimension may underestimate catheter-derived (RAPC). As right atrial (RA) deformation, measured by speckle tracking, is preload-dependent, we hypothesized that RA strain may improve estimation of RAPC. Right atrial strain components [RA reservoir function (ƐR), peak RA contraction (ƐCT) and RA conduit function (ƐCD)] were measured in 125 of 175 patients who had echocardiography and invasive measures of RAP (median difference 1 day). To determine whether RA strain measures differentiated patients with correct vs incorrect RAPIVC assessment, categories with RAPIVC values < 3, 8 and > 15 mmHg were compared with RAPC groups < 3, 4–7, 8–10, 11–14 and > 15 mmHg. Non-invasively determined RAP was significantly lower (p = 0.001) than invasively determined RAPC, with a weak correlation (r = 0.35, p < 0.001). RA strain components were associated with RA size, RV function and IVC size. In those with RAPIVC > 15 mmHg, half of patients were categorized into RAP < 10 mmHg. There were no significant differences in RA characteristics that differentiated patients in whom echocardiographic estimation of RAP was inaccurate. Right atrial strain measures were feasible, and had associations with RA size, RV systolic function and IVC size. Right atrial strain was significantly different between those with normal vs raised pressure, but it did not identify those with incorrect echocardiographic assessment of RAP.

Keywords

Right atrial pressure Inferior vena cava diameter Atrial strain 

Abbreviations

RAP

Right atrial pressure

IVC

Inferior vena cava

RV

Right ventricle

RVEDA

Right ventricular end diastolic area

RVESA

Right ventricular end systolic area

PASP

Pulmonary artery systolic pressure

RA ƐR

RA reservoir function

RA ƐCT

RA contractile reserve

RA ƐCD

RA conduit function

LVGLS

LV global longitudinal strain

RVWFS

Right ventricular free wall

RAPIVC

Right atrial pressure derived from echocardiography

RAPC

Invasively derived right atrial pressure

Notes

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent for invasive procedures was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Baker Heart and Diabetes InstituteMelbourneAustralia
  2. 2.Royal Hobart HospitalHobartAustralia
  3. 3.Princess Alexandra HospitalBrisbaneAustralia

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