3D echocardiography to evaluate right atrial pressure in acutely decompensated heart failure correlation with invasive hemodynamics

Ayan R Patel, Alawi A Alsheikh-Ali, Jayanta Mukherjee, Antonietta Evangelista, Dima Quraini, Linda J Ordway, Jeffrey T Kuvin, David Denofrio, Natesa G Pandian
JACC. Cardiovascular Imaging 2011, 4 (9): 938-45

OBJECTIVES: This study examined the utility of 3-dimensional right atrial volume index (3D-RAVi), combined with 2-dimensional echocardiographic (2DE) parameters, for the identification of elevated right atrial pressure (RAP) in patients with heart failure.

BACKGROUND: Accurate noninvasive determination of RAP is clinically important for the management of patients with heart failure. Although 2DE methods have been used to noninvasively estimate RAP, the accuracy of these parameters has limitations when estimating RAP in an individual patient. Three-dimensional echocardiography (3DE) provides tomographic imaging of right atrial volume that may be helpful in refining the noninvasive assessment of hemodynamics in patients with heart failure.

METHODS: 2DE and 3DE studies were examined in 40 initial patients who were admitted for acutely decompensated heart failure. Simultaneous pulmonary artery catheter monitoring was performed. The relationship between echocardiographic parameters and RAP was examined in this derivation group. The findings from the derivation group were then prospectively tested in a validation group of 40 additional patients.

RESULTS: Mean RAP was 11 ± 5 mm Hg (range 2 to 22 mm Hg). 3D-RAVi correlated with RAP (r = 0.51, p < 0.001), whereas 2-dimensional right atrial volume index did not. Inferior vena cava (IVC) diameter ≥2 cm and IVC respirophasic collapse <40% also correlated with RAP (p < 0.001 and p = 0.028, respectively). Based on receiver-operator characteristic curve analysis, 3D-RAVi ≥35 ml/m(2) was the optimal 3D-RAVi cutpoint for identifying RAP >10 mm Hg. The value of 3D-RAVi ≥35 ml/m(2), combined with IVC measures, for predicting RAP >10 mm Hg was prospectively tested in the validation group. 3D-RAVi ≥35 ml/m(2) in combination with IVC ≥2 cm had a high accuracy (88%) for identifying RAP >10 mm Hg and had a higher accuracy than the combination of IVC ≥2 cm and IVC collapse <40% (accuracy: 68%, p = 0.038).

CONCLUSIONS: In patients with heart failure, 3D-RAVi in conjunction with IVC parameters has a high accuracy for detection of elevated RAP. The addition of 3D-RAVi to 2DE methods may be helpful in the noninvasive estimation of right atrial pressure.

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