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


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.


Right atrial pressure Inferior vena cava diameter Atrial strain 



Right atrial pressure


Inferior vena cava


Right ventricle


Right ventricular end diastolic area


Right ventricular end systolic area


Pulmonary artery systolic pressure


RA reservoir function


RA contractile reserve


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.

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.


  1. 1.
    Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496CrossRefPubMedGoogle Scholar
  2. 2.
    Mintz GS, Kotler MN, Parry WR, Iskandrian AS, Kane SA (1981) Real-time inferior vena caval ultrasonography: normal and abnormal findings and its use in assessing right-heart function. Circulation 64:1018–1025CrossRefPubMedGoogle Scholar
  3. 3.
    Moreno FL, Hagan AD, Holmen JR, Pryor TA, Strickland RD, Castle CH (1984) Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol 53:579–585CrossRefPubMedGoogle Scholar
  4. 4.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39 e14CrossRefPubMedGoogle Scholar
  5. 5.
    Padeletti M, Cameli M, Lisi M, Malandrino A, Zaca V, Mondillo S (2012) Reference values of right atrial longitudinal strain imaging by two-dimensional speckle tracking. Echocardiography 29:147–152CrossRefPubMedGoogle Scholar
  6. 6.
    Lafitte S, Pillois X, Reant P, Picard F, Arsac F, Dijos M et al (2013) Estimation of pulmonary pressures and diagnosis of pulmonary hypertension by Doppler echocardiography: a retrospective comparison of routine echocardiography and invasive hemodynamics. J Am Soc Echocardiogr 26:457–463CrossRefPubMedGoogle Scholar
  7. 7.
    Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 86–88)CrossRefPubMedGoogle Scholar
  8. 8.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314CrossRefPubMedGoogle Scholar
  9. 9.
    Goldhammer E, Mesnick N, Abinader EG, Sagiv M (1999) Dilated inferior vena cava: a common echocardiographic finding in highly trained elite athletes. J Am Soc Echocardiogr 12:988–993CrossRefPubMedGoogle Scholar
  10. 10.
    Beigel R, Cercek B, Luo H, Siegel RJ (2013) Noninvasive evaluation of right atrial pressure. J Am Soc Echocardiogr 26:1033–1042CrossRefPubMedGoogle Scholar
  11. 11.
    Taniguchi T, Ohtani T, Nakatani S, Hayashi K, Yamaguchi O, Komuro I et al (2015) Impact of body size on inferior vena cava parameters for estimating right atrial pressure: a need for standardization? J Am Soc Echocardiogr 28:1420–1427CrossRefPubMedGoogle Scholar
  12. 12.
    Peluso D, Badano LP, Muraru D, Dal Bianco L, Cucchini U, Kocabay G et al (2013) Right atrial size and function assessed with three-dimensional and speckle-tracking echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging 14:1106–1114CrossRefPubMedGoogle Scholar
  13. 13.
    Patel AR, Alsheikh-Ali AA, Mukherjee J, Evangelista A, Quraini D, Ordway LJ et al (2011) 3D echocardiography to evaluate right atrial pressure in acutely decompensated heart failure correlation with invasive hemodynamics. JACC Cardiovasc Imaging 4:938–945CrossRefPubMedGoogle Scholar
  14. 14.
    Maniar HS, Prasad SM, Gaynor SL, Chu CM, Steendijk P, Moon MR (2003) Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load. Am J Physiol Heart Circ Physiol 284:H350–H357CrossRefGoogle Scholar
  15. 15.
    Gaynor SL, Maniar HS, Prasad SM, Steendijk P, Moon MR (2005) Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output. Am J Physiol Heart Circ Physiol 288:H2140–H2145CrossRefGoogle Scholar
  16. 16.
    Bening C, Leyh R (2016) Right atrial contractile dynamics are impaired in patients with postcapillary pulmonary hypertension. Exp Ther Med 12:792–798CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Querejeta Roca G, Campbell P, Claggett B, Solomon SD, Shah AM (2015) Right atrial function in pulmonary arterial hypertension. Circ Cardiovasc Imaging 8:e003521 (discussion e)CrossRefPubMedGoogle Scholar
  18. 18.
    Sakata K, Uesugi Y, Isaka A, Minamishima T, Matsushita K, Satoh T et al (2016) Evaluation of right atrial function using right atrial speckle tracking analysis in patients with pulmonary artery hypertension. J Echocardiogr 14:30–38CrossRefPubMedGoogle Scholar
  19. 19.
    D’Ascenzi F, Cameli M, Padeletti M, Lisi M, Zaca V, Natali B et al (2013) Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study. Int J Cardiovasc Imaging 29:87–94CrossRefPubMedGoogle Scholar
  20. 20.
    Fukuda Y, Tanaka H, Ryo-Koriyama K, Motoji Y, Sano H, Shimoura H et al (2016) Comprehensive functional assessment of right-sided heart using speckle tracking strain for patients with pulmonary hypertension. Echocardiography 33:1001–1008CrossRefPubMedGoogle Scholar
  21. 21.
    Saha SK, Soderberg S, Lindqvist P (2016) Association of right atrial mechanics with hemodynamics and physical capacity in patients with idiopathic pulmonary arterial hypertension: insight from a single-center cohort in Northern Sweden. Echocardiography 33:46–56CrossRefPubMedGoogle Scholar

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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