Right atrial pressure represents cumulative cardiac burden in heart failure with preserved ejection fraction

Abstract

AimsRight‐sided filling pressure is elevated in some patients with heart failure (HF) and preserved ejection fraction (HFpEF). We hypothesized that right atrial pressure (RAP) would represent the cumulative burden of abnormalities in the left heart, pulmonary vasculature, and the right heart.Methods and resultsEchocardiography was performed in 399 patients with HFpEF. RAP was estimated from inferior vena cava morphology and its respiratory change [estimated right atrial pressure (eRAP)], and patients were divided according to eRAP (3 or ≥8 mmHg). Patients with higher eRAP displayed more severe abnormalities in LV diastolic function as well as right heart structure and function than those with normal eRAP. Cardiac deaths or HF hospitalization occurred in 84 patients over a median follow‐up of 19.0 months (interquartile range 6.7–36.9). The presence of higher eRAP was independently associated with an increased risk of the composite outcome (adjusted hazard ratio 2.20 vs. normal eRAP group, 95% confidence interval 1.34–3.62, P = 0.002). Kaplan–Meier curves separating the patients into four groups based on eRAP and E/e' ratio showed that event‐free survival varied among the groups, providing an incremental prognostic value of eRAP over E/e' ratio. The classification and regression tree analysis demonstrated that eRAP was the strongest predictor of the outcome followed by right ventricular dimension, E/e' ratio, and estimated right ventricular systolic pressure, stratifying the patients into four risk groups (incident rate 8.8–72.2%).ConclusionsThese data may provide new insights into the prognostic role of RAP in the complex pathophysiology of HFpEF and suggest the utility of eRAP for the risk stratification in patients with HFpEF.

Improved Prognostic Performance of Right Atrial Pressure-Corrected Cardiac Power Output in Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction

“…Secondary PH and pulmonary vascular disease may enhance right ventricular afterload, subsequently contributing to right ventricular dysfunction and remodeling, leading to a further increase in RAP [ 14 , 15 ]. Previous studies have demonstrated that RAP could represent the cumulative cardiac burden in HFpEF [ 16 , 17 ], and higher RAP is independently associated with adverse outcomes in HFpEF [ 17 , 18 ]. Therefore, compared with CPO, CPO RAP integrates an additional risk factor and could better identify patients with predominantly right ventricular or biventricular involvement, which could be an explanation for the better prognostic performance for adverse outcomes of CPO RAP than CPO.…”

Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry

“…5 RAP has been shown to be of prognostic significance in patients with chronic or acute left HF, but its implications in right-sided HF remain contentious. 6,7 The recent advent of transcatheter tricuspid valve interventions (TTVI) has not only provided safe and effective means to reduce TR but also offers a model for studying right-sided HF by partly attenuating its haemodynamic basis. 5 Initial observations in patients with TR-associated right-sided HF have reported reductions in RAP following TTVI, but they found no significant associations .…”

“…These pressures are quantified by right atrial pressures (RAP), which are linked to central venous congestion 5 . RAP has been shown to be of prognostic significance in patients with chronic or acute left HF, but its implications in right‐sided HF remain contentious 6,7 …”

Capturing the pulse: a state-of-the-art review on camera-based jugular vein assessment

“…As a chronic, progressive disease, the accumulated burdens on the body over time result in frequent rehospitalisation for those diagnosed with HF, with 25% likely to be re-admitted after 30 days, and 50% likely to be re-admitted within 6 months, with a large percentage of these being avoidable [ 7 , 8 ]. Elevated central venous pressure (CVP) has been associated with rehospitalised patients both when presenting at the hospital [ 9 ], as well as the increase in time-integrated pressure out of hospital [ 10 ], suggesting this may be used as a marker for early intervention, reducing rehospitalisations [ 11 ]. Development of an at-home, non-invasive measurement of this pressure may be beneficial in this domain, as some individuals have shown interest in the use of mobile health applications to manage their own symptoms [ 12 ].…”