Inaccuracy of Right Atrial Pressure Estimates Through Inferior Vena Cava Indices

Magnino, Corrado; Omedè, Pierluigi; Avenatti, Eleonora; Presutti, Davide Giacomo; Iannaccone, Andrea; Chiarlo, M.; Moretti, Claudio; Gaïta, Fiorenzo; Veglio, Franco; Milan, Alberto

doi:10.1016/j.amjcard.2017.07.069

Cited by 73 publications

(52 citation statements)

References 13 publications

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“…Secondly, in order to obtain an estimate of PASP, the RVSP needs to be added to an estimate of the RAP derived from measurement of the inferior vena cava (IVC) dimensions and response to inspiration. However, in many patients, IVC dimensions cannot be obtained and even in those where measurement is possible, the accuracy between echo estimation of RAP and invasive measurement is as low as 34% ( 16 ). Thirdly, it is well recognised that in patients with severe free-flowing TR that the correlation between TRV and RVSP is poor and should not be performed ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Augustine¹,

Coates-Bradshaw²,

Willis³

et al. 2018

Echo Res Pract

228

175

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Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.

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Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Augustine¹,

Coates-Bradshaw²,

Willis³

et al. 2018

Echo Res Pract

228

175

View full text Add to dashboard Cite

show abstract

“…This result assumes an estimated mean right atrial pressure of 5 mmHg, which is within the normal range. We did not use right atrial pressure estimates from echocardiography, since its estimation yields poorer agreement, with an accuracy as low as 34% [15]. Moreover, assuming a right atrial pressure of 3, 8 or 15 mmHg did not change the results in any meaningful way, with a mean bias consistently below 5 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Study Participantsmentioning

confidence: 99%

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

et al. 2020

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Background: Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods: Consecutive clinically referred patients (n = 60, median [interquartile range] age 60 [48-68] years, 33% female) underwent echocardiography and CMR at 1.5 T (n = 43) or 3 T (n = 17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity > 2.8 m/s (TRPG > 31 mmHg). Results: Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p < 0.001). In cases with both an observable PA vortex and measurable TR velocity (34/ 60, 56%), TRPG was correlated with mPAP (R 2 = 0.65, p < 0.001).

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Section: Discussionmentioning

confidence: 99%

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

Ramos

Fyrdahl

Wieslander

et al. 2020

Preprint

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Background : Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods : Consecutive clinically referred patients (n=60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5T (n=43) or 3T (n=17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity >2.8 m/s (TRPG >31 mmHg). Results : Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p<0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 =0.65, p<0.001). Conclusions : There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.

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Inaccuracy of Right Atrial Pressure Estimates Through Inferior Vena Cava Indices

Cited by 73 publications

References 13 publications

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

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

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

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