Association with right atrial strain with right atrial pressure: an invasive validation study
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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.
KeywordsRight atrial pressure Inferior vena cava diameter Atrial strain
Right atrial pressure
Inferior vena cava
Right ventricular end diastolic area
Right ventricular end systolic area
Pulmonary artery systolic pressure
- RA ƐR
RA reservoir function
- RA ƐCT
RA contractile reserve
- RA ƐCD
RA conduit function
LV global longitudinal strain
Right ventricular free wall
Right atrial pressure derived from echocardiography
Invasively derived right atrial pressure
Compliance with ethical standards
Conflict of interest
None of the authors have any conflicts of interest.
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 for invasive procedures was obtained from all individual participants included in the study.
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