AUTHOR=Toma Matteo , Giovinazzo Stefano , Crimi Gabriele , Masoero Giovanni , Balbi Manrico , Montecucco Fabrizio , Canepa Marco , Porto Italo , Ameri Pietro 

TITLE=Multiparametric vs. Inferior Vena Cava–Based Estimation of Right Atrial Pressure

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.632302

DOI=10.3389/fcvm.2021.632302

ISSN=2297-055X

ABSTRACT=Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e’ ratio (eRAPE/e’) or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments. 
Methods and results: eRAPIVC, eRAPE/e’, eRAPHV (categorized in 5, 10, 15 or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization (median age 69 (58-75) years, 49% males). There was a positive correlation between eRAPmean and iRAP (Spearman test r=0.66, P <0.001), with Bland-Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, eRAPE/e’, eRAPHV and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e’ and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P=0.02 and P<0.001, respectively). The area under the curve in predicting iRAP were non-significantly better for eRAPmean than for eRAPIVC at both 5-mmHg (0.64, 95%CI 0.49-0.80 vs. 0.70, 95%CI 0.53-0.87; Wald test P=0.41) and 10-mmHg (0.76, 95%CI 0.60-0.92 vs. 0.81, 95%CI 0.67-0.96; P=0.43) thresholds. 
Conclusions: Our data suggest that multi-parametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.