Multiparametric vs. Inferior Vena Cava-Based Estimation of Right Atrial Pressure

Matteo Toma; Stefano Giovinazzo; Gabriele Crimi; Giovanni Masoero; Manrico Balbi; Fabrizio Montecucco; Marco Canepa; Italo Porto; Pietro Ameri

doi:10.3389/fcvm.2021.632302

Multiparametric vs. Inferior Vena Cava-Based Estimation of Right Atrial Pressure

Front Cardiovasc Med. 2021 Mar 8:8:632302. doi: 10.3389/fcvm.2021.632302. eCollection 2021.

Authors

Matteo Toma^{1

2}, Stefano Giovinazzo¹, Gabriele Crimi¹, Giovanni Masoero¹, Manrico Balbi^{1

2}, Fabrizio Montecucco^{2

3}, Marco Canepa^{1

2}, Italo Porto^{1

2}, Pietro Ameri^{1

2}

Affiliations

¹ Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.
² Department of Internal Medicine, University of Genova, Genova, Italy.
³ First Clinic of Internal Medicine, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.

Abstract

Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAP_IVC), tricuspid E/e' ratio ( ${eRAP}_{E / e^{'}}$ ), or hepatic vein flow (eRAP_HV). The mean of these estimates (eRAP_mean) might be more accurate than single assessments. Methods and Results: eRAP_IVC, ${eRAP}_{E / e^{'}}$ , eRAP_HV (categorized in 5, 10, 15, or 20 mmHg), eRAP_mean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58-75) years, 49% males]. There was a positive correlation between eRAP_mean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland-Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAP_IVC, ${eRAP}_{E / e^{'}}$ , eRAP_HV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from ${eRAP}_{E / e^{'}}$ and eRAP_HV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAP_mean than for eRAP_IVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49-0.80 vs. 0.70, 95% CI 0.53-0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60-0.92 vs. 0.81, 95% CI 0.67-0.96; P = 0.43) thresholds. Conclusions: Our data suggest that multiparametric eRAP_mean does not provide advantage over eRAP_IVC, despite being more complex and time-consuming.

Keywords: echocardiograghy; heart failure; pulmonary hypertension; right atrial pressure; right heart catheterization.