Abstract 2241: Tricuspid E/e’ Identifies Elevated Mean Right Atrial Pressures
Background: Tissue Doppler (TDI) and Doppler echocardiography (Echo) has been successfully used to estimate filling pressures (FP) of the left ventricle (LV) and LV diastolic function. However, there is a paucity of data regarding Doppler and TDI parameters in estimation of right ventricular (RV) FP.
Objectives: To assess the value of tricuspid (TV) inflow Doppler, TDI of the lateral TV annulus, and M-mode diastolic slope of the lateral tricuspid annular motion (TAM) in estimating mean right atrial pressure (mRAP) compared to invasive mRAP.
Methods: One hundred patients who underwent cardiac surgery were prospectively enrolled. Intraoperative transesophageal Echo were performed simultaneously with measurement of mRAP obtained with Swan Ganz catheters.
Results: Mean age was 63 ± 14. Mean RAP was significantly correlated with the ratio of TV E wave (E) velocity to TV annulus early diastolic velocity (e’) (TV E/e’), and inversely correlated with TV E wave deceleration time (TV E DT) and lateral TV e’ velocity. TV E and A velocities, Diastolic slope of TAM, late diastolic tissue velocity of TV annulus (TV a’), and TV e’/a’ did not predict elevated mRAP. Receiver operating characteristic (ROC) curve for TV DT, TV e’, and TV E/e’ were determined (Table⇓), and the best area under the curve for predicting mRAP > 10 mmHg was TV E/e’. All patients with TV E/e’>12 had mRAP >10 mmHg, and 100% of those with TV E/e’ <2 had mRAP > 10 mmHg. Wide variability presented in those with TV E/e’ of 2 to 12. The most predictive bivariate model included TV E/e’ (p <0.01) and TV E DT (p 0.04); adding the third variable (TV e’, TV a’, TV E, TV A, or diastolic TAM) to the model did not significantly improve the predictive ability. When using TV E/e’ and TV DT, the ROC curve area was 0.79.
Conclusion: Mean RA pressure can reliably estimated by the use of Tricuspid annulus e’ velocity as well as Tricuspid E/e’ ratio.