The precision of echocardiography in estimating pulmonary pressures has been debated.
A value of right atrial pressure (RAP) is needed for pulmonary pressure estimation,
and it could be partly responsible for the estimation error. Several schemes based
on the inferior vena cava (IVC) are commonly used in clinical practice and in experimental
studies for RAP estimation. However, the majority lack proper validation, and thus
far, no study has compared them all. In this prospective, blinded study, a comprehensive
transthoracic echocardiography was performed on 200 patients referred for right heart
catheterization. The IVC was measured in different views and RAP was estimated according
to 6 different schemes. One hundred ninety patients were suitable for analysis. IVC
measurements were significantly but poorly associated with invasive RAP. All RAP schemes
showed poor accuracy compared with invasive RAP (average accuracy 34%). None of the
schemes showed a clear superiority over the others. No echocardiographic or clinical
variables showed a relevant impact on the estimation error. In conclusion, RAP estimation
based on the IVC is highly inaccurate irrespective of the method used and should be
avoided whenever possible. Whether adding estimated RAP values affects the estimation
of pulmonary pressures is yet to be determined.
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References
- Echocardiographic indexes for the non-invasive evaluation of pulmonary hemodynamics.J Am Soc Echocardiogr. 2010; 23: 225-239
- Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava.Am J Cardiol. 1990; 66: 493-496
- A new formula for echo-Doppler estimation of right ventricular systolic pressure.J Am Soc Echocardiogr. 1994; 7: 20-26
- Reappraisal of the use of inferior vena cava for estimating right atrial pressure.J Am Soc Echocardiogr. 2007; 20: 857-861
- Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
- Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463
- Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension.Am J Respir Crit Care Med. 2009; 179: 615-621
- Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice.Chest. 2011; 139: 988-993
- Definitions and diagnosis of pulmonary hypertension.J Am Coll Cardiol. 2013; 62: D42-D50
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vienna, Austria2016 (Available at:)http://www.r-project.orgDate accessed: August 2, 2016
- Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration.Am Rev Respir Dis. 1979; 120: 421-427
- Noninvasive evaluation of right atrial pressure.J Am Soc Echocardiogr. 2013; 26: 1033-1042
- Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis.Heart. 2011; 97: 612-622
- Impact of body size on inferior vena cava parameters for estimating right atrial pressure: a need for standardization?.J Am Soc Echocardiogr. 2015; 28: 1420-1427
- 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2015; 37: ehv317
Article info
Publication history
Published online: July 31, 2017
Accepted:
July 21,
2017
Received:
April 29,
2017
Footnotes
The Writing Committee Members for RIGHT1 Investigators include the following: Caterina Bucca, MD, Department of Clinical Physiopathology, University of Turin; Mara Morello, MD, Chair of Cardiology, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; Walter Grosso Marra, MD, Chair of Cardiology, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; Isabel Losano, MD, Internal and Hypertension Division, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin; and Agnese Ravera, MD, Internal and Hypertension Division, Department of Medical Sciences, AOU Citta' Salute e Scienza of Turin, University of Turin.
Funding sources: None.
See page 1672 for disclosure information.
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