(Circulation. 1996;93:1160-1169.)
© 1996 American Heart Association, Inc.
Articles |
Relation of Mean Right Atrial Pressure to Echocardiographic and Doppler Parameters of Right Atrial and Right Ventricular Function
Presented in part at the 44th Annual Scientific Session of the American College of Cardiology, New Orleans, La, March 20, 1995.
From the Section of Cardiology, Department of Medicine, Baylor College of Medicine and The Methodist Hospital, Echocardiography Laboratory, Houston, Tex.
Correspondence to William A. Zoghbi, MD, Director of Echocardiography Research, Baylor College of Medicine and The Methodist Hospital, 6550 Fannin, SM 677, Houston, TX 77030.
Background A paucity of data exists as to the relation of mean right atrial pressure (RAP) to Doppler parameters of right atrial and ventricular filling. Furthermore, whether echocardiographic parameters of right atrial and right ventricular function and inferior vena cava improve the relation of Doppler filling dynamics with RAP has not been explored.
Methods and Results Doppler and echocardiographic studies were performed simultaneously with measurements of mean RAP in consecutive patients who either had a central venous catheter in the Intensive Care Unit or underwent catheterization of the right side of the heart. The initial population consisted of 35 patients with a mean age (±SD) of 60±15 years; 34% were on mechanical ventilation. Mean RAP averaged 9±5.7 mm Hg (range, 2 to 28 mm Hg). Among tricuspid inflow parameters, the strongest relation with RAP was observed with the ratio of early to late velocity (r=.66). For hepatic venous flow, systolic filling wave indexes had the best relation with atrial pressure, the highest being for systolic filling fraction (r=-.86). Weaker relations were noted with the use of right atrial volumes, right ventricular function, and inferior vena caval diameters. The addition of any of these variables did not improve the relation of systolic filling fraction with RAP. The regression equation (RAP=21.6-24 systolic filling fraction) was tested prospectively in the estimation of atrial pressure in 50 patients. The correlation coefficient was .89 in the prospective group and .88 in the total group of 85 patients. The mean difference between predicted and actual pressures in the whole population was -0.2±2.6 mm Hg. The sensitivity and specificity for mean RAP>8 mm Hg were 86% and 92%, respectively.
Conclusions Among echocardiographic and Doppler parameters of right atrial and right ventricular function, hepatic venous flow dynamics relate best to mean atrial pressure and can be used clinically to estimate mean RAP.
Key Words: diastole • echocardiography • ventricles • pressure • atrium
This article has been cited by other articles:
 |
|
 |
|
  P. Innelli, R. Esposito, M. Olibet, S. Nistri, and M. Galderisi The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study Eur J Echocardiogr, June 1, 2009; 10(4): 491 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Mutlak, D. Aronson, J. Lessick, S. A. Reisner, S. Dabbah, and Y. Agmon Functional Tricuspid Regurgitation in Patients With Pulmonary Hypertension: Is Pulmonary Artery Pressure the Only Determinant of Regurgitation Severity? Chest, January 1, 2009; 135(1): 115 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. N. Goonewardena, A. Gemignani, A. Ronan, S. Vasaiwala, J. Blair, J. M. Brennan, D. P. Shah, and K. T. Spencer Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic Peptide for predicting readmission after hospitalization for acute decompensated heart failure. J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 595 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Brechot, L. Gambotti, S. Lafitte, and R. Roudaut Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure Eur J Echocardiogr, July 1, 2008; 9(4): 547 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Agarwal, M. J. Andersen, and J. H. Pratt On the Importance of Pedal Edema in Hemodialysis Patients Clin. J. Am. Soc. Nephrol., January 1, 2008; 3(1): 153 - 158. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Cortina, J. Bermejo, R. Yotti, M. M. Desco, D. Rodriguez-Perez, J. C. Antoranz, J. L. Rojo-Alvarez, D. Garcia, M. A. Garcia-Fernandez, and F. Fernandez-Aviles Noninvasive Assessment of the Right Ventricular Filling Pressure Gradient Circulation, August 28, 2007; 116(9): 1015 - 1023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Kirkpatrick, M. A. Vannan, J. Narula, and R. M. Lang Echocardiography in Heart Failure: Applications, Utility, and New Horizons J. Am. Coll. Cardiol., July 31, 2007; 50(5): 381 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Snyder, K. C. Beck, M. L. Hulsebus, J. F. Breen, E. A. Hoffman, and B. D. Johnson Short-term hypoxic exposure at rest and during exercise reduces lung water in healthy humans J Appl Physiol, December 1, 2006; 101(6): 1623 - 1632. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Piazza and S. Z. Goldhaber The Acutely Decompensated Right Ventricle: Pathways for Diagnosis and Management Chest, September 1, 2005; 128(3): 1836 - 1852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Beaulieu and P. E. Marik Bedside Ultrasonography in the ICU: Part 1 Chest, August 1, 2005; 128(2): 881 - 895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Vourvouri, A. F.L. Schinkel, J. R.T.C. Roelandt, F. Boomsma, G. Sianos, M. Bountioukos, F. B. Sozzi, V. Rizzello, J. J. Bax, H. I. Karvounis, et al. Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device Eur J Heart Fail, December 1, 2003; 5(6): 767 - 774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Zoghbi, M. Enriquez-Sarano, E. Foster, P. A. Grayburn, C. D. Kraft, R. A. Levine, P. Nihoyannopoulos, C. M. Otto, M. A. Quinones, H. Rakowski, et al. American Society of Echocardiography: recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography : A report from the American Society of Echocardiography's Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee, Council on Clinical Cardiology, The American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by: Eur J Echocardiogr, December 1, 2003; 4(4): 237 - 261. [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. Desser, D. Y. Sze, and R. B. Jeffrey Imaging and Intervention in the Hepatic Veins Am. J. Roentgenol., June 1, 2003; 180(6): 1583 - 1591. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Meierhenrich, A. Gauss, M. Georgieff, and W. Schutz Use of multi-plane transoesophageal echocardiography in visualization of the main hepatic veins and acquisition of Doppler sonography curves. Comparison with the transabdominal approach Br. J. Anaesth., November 1, 2001; 87(5): 711 - 717. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Giunta, E. Tirri, S. Maione, S. Cangianiello, A. Mele, A. De Luca, and G. Valentini Right ventricular diastolic abnormalities in systemic sclerosis. Relation to left ventricular involvement and pulmonary hypertension Ann Rheum Dis, February 1, 2000; 59(2): 94 - 98. [Abstract] [Full Text]
|
|
|
|
|
|
M. Y. Henein, C. A. O'Sullivan, A. J. S. Coats, and D. G. Gibson Angiotensin-converting enzyme (ACE) inhibitors revert abnormal right ventricular filling in patients with restrictive left ventricular disease J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1187 - 1193. [Abstract] [Full Text] [PDF]
|
|