Document Detail

Evaluation of mean right atrial pressure by two-dimensional and Doppler echocardiography in patients with cardiac disease.
MedLine Citation:
PMID:  9616849     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several approaches have been used for noninvasive estimation of right atrial pressure (RAP), but, no currently available method has gained any definite validation. The purpose of this study was to evaluate the accuracy of two-dimensional and Doppler echocardiography in estimating mean RAP in patients with cardiac disease. METHODS: We examined the relation of mean RAP to right atrial size and function, size and respiratory changes of inferior vena cava and Doppler parameters of tricuspid and hepatic vein flow in 114 consecutive patients (77 men, 37 women; mean age 57 +/- 12 years) with various cardiac diseases undergoing cardiac catheterization. Echocardiographic studies were performed within 24 hours before catheterization (mean interval 6 +/- 3 hours). Patients were assigned to 3 groups according to the values of mean RAP (group 1, < or = 8 mmHg; group 2, between 9 and 12 mmHg; group 3, > 12 mmHg). RESULTS: Mean RAP ranged from 3 to 20 mmHg (mean 9.1 +/- 4.3 mmHg). It correlated most strongly with the collapsibility index of inferior vena cava (IVCCI) (r = -0.76), minimal inspiratory diameter of inferior vena cava (r = 0.72) and deceleration time of early tricuspid flow (DT) (r = -0.61). Discriminant analysis demonstrated that IVCCI and DT were major determinants of mean RAP with 81.6% of cases correctly assigned to study groups: 96% of patients of group 1 and 87% of patients of group 3 were identified, whereas the accuracy in identifying the patients of group 2 was lower (46%). An IVCCI > 45% was the best cutoff point in predicting a mean RAP < or = 8 mmHg; an IVCCI < 35% and a DT < 150 msec were the best cutoff points in predicting a mean RAP > or = 15 mmHg. The best multivariate equation predicting mean RAP was: mean RAP = 23.3 - 0.2 IVCCI -0.026 DT (r = 0.80, R2 = 0.64). This equation was 81% sensitive and 84% specific in detecting a mean RAP < or = 8 mmHg and 74% sensitive and 97% specific in detecting a mean RAP > 12 mmHg. CONCLUSIONS: Mean RAP can be estimated noninvasively by two-dimensional and Doppler echocardiography. The combined analysis of IVCCI and DT provides an accurate prediction on mean RAP < or = 8 mmHg and > 12 mmHg, whereas the prediction of intermediate values is less accurate.
M Cecconi; G La Canna; M Manfrin; P Colonna; M Nardi; R Zanoli; S Moretti; D Gabrielli; A Pangrazi; A Soro
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Giornale italiano di cardiologia     Volume:  28     ISSN:  0046-5968     ISO Abbreviation:  G Ital Cardiol     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-07-13     Completed Date:  1998-07-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1270331     Medline TA:  G Ital Cardiol     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  357-64     Citation Subset:  IM    
Azienda Ospedaliera G.M. Lancisi, Ancona.
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MeSH Terms
Aged, 80 and over
Atrial Function, Right / physiology*
Blood Pressure / physiology*
Echocardiography, Doppler
Heart Catheterization
Heart Diseases / physiopathology*,  ultrasonography
Middle Aged
Reproducibility of Results

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