Estimating Right Atrial Pressure Using Ultrasounds: An Old Issue Revisited With New Methods

Abstract

Knowledge of the right atrial pressure (RAP) values is critical to ascertain the existence of a state of hemodynamic congestion, irrespective of the possible presence of signs and symptoms of clinical congestion and cardiac overload that can be lacking in some conditions of concealed or clinically misleading cardiac decompensation. In addition, a more reliable estimate of RAP would make it possible to determine more accurately also the systolic pulmonary arterial pressure with the only echocardiographic methods. The authors briefly illustrate some of the criteria that have been implemented to obtain a non-invasive RAP estimate, some of which have been approved by current guidelines and others are still awaiting official endorsement from the Scientific Societies of Cardiology. There is a representation of the sometimes opposing views of researchers who have studied the problem, and the prospects for development of new diagnostic criteria are outlined, in particular those derived from the matched use of two- and three-dimensional echocardiographic parameters.

Non-invasive assessment of central venous pressure in heart failure: a systematic prospective comparison of echocardiography and Swan-Ganz catheter

“…Given the clinical implications of such measurements in guiding medical strategy in HF decompensation or cardiogenic shock, the discrepancies between 2DE estimations and actual CVP values are concerning [ 13 ]. Thus, a more accurate noninvasive approach for CVP assessment is required [ 14 ].…”

Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure

“…Interestingly, our regression equation when comparing CMR mPAP with TRPG was remarkably similar to Chemla's equation to convert TRPG to mPAP, albeit with an assumed right atrial pressure of 5 mmHg. Furthermore, since echocardiography mPAP = 0.61 sPAP + 2 (Equation 1) [12] and sPAP = 4v 2 + RAP (Equation 2), by assuming a RAP of 5 mmHg [14], by substitution we get…”

“…The study included consecutive patients (n = 60) referred for CMR due to known or suspected cardiopulmonary disease. Time between echocardiography and CMR was 6 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] days. Patient characteristics are summarized in Table 1 and CMR characteristics are summarized in Table 2.…”

Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure

“…When both methods yielded detectable estimates of PA pressure, we found good agreement between CMR mPAP and echo TRPG, which supports the accuracy of blood flow vortex duration in mPAP estimation. Interestingly, our regression equation when comparing CMR mPAP with TRPG was remarkably similar to Chemla's equation to convert TRPG to mPAP, albeit with an assumed right atrial pressure of 5 mmHg.Furthermore, since echocardiography (Equation 1)[12] and (Equation 2), by assuming a RAP of 5 mmHg[14], by substitution we get (Equation 3), which is the relationship one would mathematically expect between mPAP and TRPG. Interestingly, this derived equation is very similar to the regression equation we obtained in figure 2, i.e.…”