Skip to main content

Advertisement

Log in

Echocardiographic surrogates of right atrial pressure in pulmonary hypertension

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Swiston JR, Johnson SR, Granton JT (2010) Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: a systematic review of the literature. Respir Med 104:1588–607

    Article  PubMed  Google Scholar 

  2. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, ESC Scientific Document Group (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37:67–119

    Article  Google Scholar 

  3. Weinberger SE, Drazen JM (1998) Disturbances of respiratory function. In: Harrison TR (ed) A textbook of principles of internal medicine, 14th edn. McGraw-Hill, New-York, pp 1410–1407

    Google Scholar 

  4. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (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

    Article  Google Scholar 

  5. 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 66:493–496

    Article  CAS  PubMed  Google Scholar 

  6. Sade LE, Gulmez O, Eroglu S, Sezgin A, Muderrisoglu H (2007) Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr 20:982–988

    Article  PubMed  Google Scholar 

  7. Said K, Shehata A, Ashour Z, El-Tobgi S (2012) Value of conventional and tissue Doppler echocardiography in the noninvasive measurement of right atrial pressure. Echocardiography 29:779–784

    Article  PubMed  Google Scholar 

  8. Hoeper MM, Lee SH, Voswinckel R, Palazzini M, Jais X, Marinelli A, Barst RJ, Ghofrani HA, Jing ZC, Opitz C, Seyfarth HJ, Halank M, McLaughlin V, Oudiz RJ, Ewert R, Wilkens H, Kluge S, Bremer HC, Baroke E, Rubin LJ (2006) Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 48:2546–2552

    Article  PubMed  Google Scholar 

  9. Ranu H, Smith K, Nimako K, Sheth A, Madden BP (2010) A retrospective review to evaluate the safety of right heart catheterization via internal jugular vein in the assessment of pulmonary hypertension. Clin Cardiol 33:303–306

    Article  PubMed  Google Scholar 

  10. Taylor CJ, Derrick G, McEwan A, Haworth SG, Sury MR (2007) Risk of cardiac cathererization under anesthesia in children with pulmonary hypertension. Br J Anaesth 98:657–661

    Article  CAS  PubMed  Google Scholar 

  11. Briongos Figuero S, Moya Mur JL, García-Lledó A, Centella T, Salido L, Aceña Navarro Á, García Martín A, García-Andrade I, Oliva E, Zamorano JL (2016) Predictors of persistent pulmonary hypertension after mitral valve replacement. Heart Vessels 31:1091–1099

    Article  PubMed  Google Scholar 

  12. Hioka T, Kaga S, Mikami T, Okada K, Murayama M, Masauzi N, Nakabachi M, Nishino H, Yokoyama S, Nishida M, Iwano H, Sakakibara M, Yamada S, Tsutsui H (2017) Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure. Heart Vessels 32:833–842

    Article  PubMed  Google Scholar 

  13. Fukuda R, Amano H, Nishida H, Yamauchi F, Inoue T (2016) Estimation of pulmonary vascular resistance by echocardiographic parameters in patients with pulmonary hypertension. J Clin Physiol 46:31–37 (in Japanese)

    Google Scholar 

  14. Amano H, Abe S, Hirose S, Waku R, Masuyama T, Sakuma M, Toyoda S, Taguchi I, Inoue T, Tei C (2017) Comparison of echocardiographic parameters to assess right ventricular function in pulmonary hypertension. Heart Vessels 32:1214–1219

    Article  PubMed  Google Scholar 

  15. Thomas L, Levett K, Boyd A, Leung DY, Schiller NB, Ross DL (2003) Changes in regional left atrial function with aging: evaluation by Doppler tissue imaging. Eur J Echocardiogr 4:92–100

    Article  CAS  PubMed  Google Scholar 

  16. Pelà G, Regolisti G, Coghi P, Cabassi A, Basile A, Cavatorta A, Manca C, Borghetti A (2004) Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects. Eur J Echocardiogr 5:262–271

    Article  PubMed  Google Scholar 

  17. Nadorlik H, Stiver C, Khan S, Miao Y, Holzer R, Cheatham JP, Cua CL (2017) Echocardiographic right ventricular function correlations with cardiac catheterisation data in biventricular congenital heart patients. Cardiol Young 27:1186–1193

    Article  PubMed  Google Scholar 

  18. Sitbon O, Humbert M, Nunes H, Parent F, Garcia G, Hervé P, Rainisio M, Simonneau G (2002) Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival. J Am Coll Cardiol 40:780–788

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Teruo Inoue.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watanabe, R., Amano, H., Saito, F. et al. Echocardiographic surrogates of right atrial pressure in pulmonary hypertension. Heart Vessels 34, 477–483 (2019). https://doi.org/10.1007/s00380-018-1264-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-018-1264-8

Keywords

Navigation