Original Article
Assessment of Right Atrial Pressure With 2-Dimensional and Doppler Echocardiography: A Simultaneous Catheterization and Echocardiographic Study

https://doi.org/10.4065/75.1.24Get rights and content

Objective

To derive a clinically useful, noninvasive determination of right atrial pressure. Noninvasive assessment of right ventricular systolic pressure from Doppler-derived tricuspid regurgitant velocity requires an accurate assumption of right atrial pressure.

Patients and Methods:

Seventy-one patients were studied in the cardiac catheterization laboratory, comparing right atrial pressure (measured at mid systole) with simultaneous 2-dimensional echocardiographic measurement of inferior vena cava diameter and Doppler recordings of hepatic vein systolic, diastolic, and atrial reversal velocities. The initial 28 patients were used to derive a clinical algorithm to predict right atrial pressure, which was tested in the subsequent 43 patients.

Results:

Inferior vena cava dimension correlated directly with right atrial pressure (r2=0.74; P<.001). The systolic filling fraction of the hepatic vein velocity curves correlated poorly with right atrial pressure. However, the correlation between the hepatic vein Doppler sum of systolic forward flow velocity and atrial reversal velocity and right atrial pressure was inverse (r2=0.32; P=.002). With a combination of variables from both inferior vena cava diameter and hepatic vein velocity curves, patients can be divided into those with normal right atrial pressure, mildly increased right atrial pressure, and severely increased right atrial pressure.

Conclusion:

The combined information from inferior vena cava diameter and hepatic vein velocity curves can be used to assess right atrial pressure.

Section snippets

PATIENTS AND METHODS

The study population consisted of 71 patients who underwent simultaneous catheterization and 2-dimensional and Doppler echocardiography. All patients were referred to the Catheterization Laboratory at Mayo Clinic Rochester for clinically indicated catheterization of the right side of the heart; they were hemodynamically stable and in normal sinus rhythm. The initial 28 patients (derivation set) were used to derive a regression equation and clinical algorithm to predict right atrial pressure.

RESULTS

The derivation patients were 54±14 years old, with an ejection fraction of 48%±22%. The referring diagnoses included constrictive pericarditis in 4 patients, restrictive cardiomyopathy in 2, mitral stenosis in 3, aortic stenosis in 3, hypertrophic cardiomyopathy in 2, and clinical heart failure in the other 14. The test set was not significantly different. They were 58±12 years old, with an ejection fraction of 45%±17%. The referring diagnoses included hypertrophic cardiomyopathy in 2 patients,

DISCUSSION

Several methods have been proposed for estimating right atrial pressure, which is needed to determine right ventricular systolic pressure echocardiographically. Clinical estimation of the venous pressure has been used, but prospective studies have shown that it is inaccurate.5, 6 A constant value of 14 mm Hg has been derived from a regression analysis comparing the tricuspid regurgitant velocity with direct catheter measurement of right ventricular systolic pressure in a large number of

ACKNOWLEDGMENT

We wish to thank Timothy F. Christian, MD, for his assistance with the statistical methods and critical review of the manuscript.

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1

Dr Hurrell is now with the Minneapolis Heart Institute Foundation, Minneapolis, Minn.

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