Echocardiographic surrogates of right atrial pressure in pulmonary hypertension

Watanabe, Ryoji; Amano, Hirohisa; Saito, Fumie; Toyoda, Shigeru; Sakuma, Masashi; Abe, Shichiro; Nakajima, Toshiaki; Inoue, Teruo

doi:10.1007/s00380-018-1264-8

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…Individual comparisons of eRAP IVC , eRAP E/e ′ , and eRAP HV with iRAP have already been drawn (6)(7)(8)(24)(25)(26)(27). By contrast, to our knowledge, only one recent investigation with LVAD patients considered eRAP IVC , eRAP E/e ′ , and eRAP HV together to compute eRAP mean (14).…”

Section: Discussionmentioning

confidence: 99%

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

Toma

Giovinazzo

Masoero

et al. 2021

Front. Cardiovasc. Med.

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Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e′ ratio (eRAPE/e′), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments.Methods and Results: eRAPIVC, eRAPE/e′, eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (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 eRAPmean 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 eRAPIVC, eRAPE/e′, eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e′ and eRAPHV 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 eRAPmean than for eRAPIVC 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 eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.

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Section: Discussionmentioning

confidence: 99%

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

Toma

Giovinazzo

Masoero

et al. 2021

Front. Cardiovasc. Med.

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“…Increased PA pressures can alter hepatic venous (HV) flows and IVC diameter leading to a reduction in the forward flow from the HV to the RV. An increase in IVC diameter reflects an increase in back pressure from the right atrium as a result of increase in RV afterload and can serve as a prognostic indicator of PH ( 30 ). Hepatic venous flow was shown to plateau after 3 weeks reflecting sensitivity only during the initial phases of development of PAH.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic, Biochemical, and Electrocardiographic Correlates Associated With Progressive Pulmonary Arterial Hypertension

Zaky

Zafar

Masjoan-Juncos

et al. 2021

Front. Cardiovasc. Med.

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Background: Pulmonary arterial hypertension (PAH) is a progressive proliferative vasculopathy associated with mechanical and electrical changes, culminating in increased vascular resistance, right ventricular (RV) failure, and death. With a main focus on invasive tools, there has been an underutilization of echocardiography, electrocardiography, and biomarkers to non-invasively assess the changes in myocardial and pulmonary vascular structure and function during the course of PAH.Methods: A SU5416-hypoxia rat model was used for inducing PAH. Biventricular functions were measured using transthoracic two-dimensional (2D) echocardiography/Doppler (echo/Doppler) at disease onset (0 week), during progression (3 weeks), and establishment (5 weeks). Similarly, electrocardiography was performed at 0, 3, and 5 weeks. Invasive hemodynamic measurements and markers of cardiac injury in plasma were assessed at 0, 3, and 5 weeks.Results: Increased RV systolic pressure (RVSP) and rate of isovolumic pressure rise and decline were observed at 0, 3, and 5 weeks in PAH animals. EKG showed a steady increase in QT-interval with progression of PAH, whereas P-wave height and RS width were increased only during the initial stages of PAH progression. Echocardiographic markers of PAH progression and severity were also identified. Three echocardiographic patterns were observed: a steady pattern (0–5 weeks) in which echo parameter changed progressively with severity [inferior vena cava (IVC) expiratory diameter and pulmonary artery acceleration time (PAAT)], an early pattern (0–3 weeks) where there is an early change in parameters [RV fractional area change (RV-FAC), transmitral flow, left ventricle (LV) output, estimated mean PA pressure, RV performance index, and LV systolic eccentricity index], and a late pattern (3–5 weeks) in which there is only a late rise at advanced stages of PAH (LV diastolic eccentricity index). RVSP correlated with PAAT, PAAT/PA ejection times, IVC diameters, RV-FAC, tricuspid systolic excursion, LV systolic eccentricity and output, and transmitral flow. Plasma myosin light chain (Myl-3) and cardiac troponin I (cTnI) increased progressively across the three time points. Cardiac troponin T (cTnT) and fatty acid-binding protein-3 (FABP-3) were significantly elevated only at the 5-week time point.Conclusion: Distinct electrocardiographic and echocardiographic patterns along with plasma biomarkers were identified as useful non-invasive tools for monitoring PAH progression.

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“…Moreover, the diastolic LV eccentricity index, a consequence of prolonged RV contraction in response to elevated PASP, is evident in severe PH and prognosticates adverse outcomes [46]. Increased RAP, reflecting right heart failure, is a crucial prognostic indicator in PH [60,62], and the echocardiographic parameter A' (a reflection of atrial contraction) is the most accurate surrogate of catheterization-based RAP [63].…”

Section: Right Ventricular Functionmentioning

confidence: 99%

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

Kadoglou,

Khattab,

Velidakis

et al. 2024

JPM

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The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s′), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.

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Echocardiographic surrogates of right atrial pressure in pulmonary hypertension

Cited by 7 publications

References 17 publications

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

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

Echocardiographic, Biochemical, and Electrocardiographic Correlates Associated With Progressive Pulmonary Arterial Hypertension

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

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