Reappraisal of the Use of Inferior Vena Cava for Estimating Right Atrial Pressure

doi:10.1016/j.echo.2007.01.005

Journal of the American Society of Echocardiography

Volume 20, Issue 7, July 2007, Pages 857-861

https://doi.org/10.1016/j.echo.2007.01.005 Get rights and content

Estimation of right atrial pressure (RAP) using echocardiographic measurement of the inferior vena caval (IVC) size along with its respirophasic variation is commonly performed despite the paucity of data that critically evaluates this technique. In this study, we systematically evaluated echocardiographic imaging of the IVC for estimation of RAP in 102 patients undergoing right heart catheterization. This study established cut-off values using receiver operating characteristic analysis for 8 different IVC parameters and then prospectively tested these parameters for their ability to predict an elevated RAP. The IVC size cutoff with optimum predictive use for RAP above or below 10 mm Hg was 2.0 cm (sensitivity 73% and specificity 85%) and the optimal IVC collapsibility cutoff was 40% (sensitivity 73% and specificity 84%). Traditional classification of RAP into 5-mm Hg ranges based on IVC size and collapsibility performed poorly (43% accurate) and a new classification scheme is proposed.

Section snippets

Methods

Our institutional review board approved the protocol. In all, 102 patients referred for right heart catheterization at our institution were enrolled. The patients were divided into two groups: the first used to derive cut-off points (derivation group) and the second to validate them in a test population (test group). The patients were selected consecutively without regard for their medical history or the quality of their echocardiographic images. Baseline patient demographics including age,

Study Population

In all, 102 patients were enrolled (50 derivation group; 52 test group). Eleven patients had inadequate IVC examinations (5 in derivation group and 6 in test group). Indications for right heart catheterization included: postcardiac transplant evaluation (30%), pulmonary hypertension (29%), congestive heart failure (32%), and other (11%, valvular heart disease, preliver transplant, constriction, pericardial effusion). Of the patients, 9% were in atrial fibrillation. Demographic data along with

Discussion

Despite the widespread use of IVC size and respirophasic size change for estimation of RAP in clinical echocardiographic laboratories, there is a paucity of data that critically evaluates the commonly used cutoffs or compares which parameters are most accurate.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 Multiple studies have demonstrated fair to excellent correlations, similar to those seen in this study, between RAP and a variety of IVC parameters.8, 9, 11, 12, 13, 14, 15, 16, 18 However,

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Original articleReappraisal of the Use of Inferior Vena Cava for Estimating Right Atrial Pressure

Section snippets

Methods

Study Population

Discussion

J Am Coll Cardiol

J Am Coll Cardiol

Chest

Am J Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Mayo Clin Proc

J Am Soc Echocardiogr

Original article
Reappraisal of the Use of Inferior Vena Cava for Estimating Right Atrial Pressure