Multiparametric vs. Inferior Vena Cava-Based Estimation of Right Atrial Pressure

Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAP(IVC)), tricuspid E/e ' ratio (eRAPE/e '), or hepatic vein flow (eRAP(HV)). The mean of these estimates (eRAP(mean)) might be more accurate than single assessments.Methods and Results: eRAP(IVC), eRAPE/e ', eRAP(HV) (categorized in 5, 10, 15, or 20 mmHg), eRAP(mean) (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 eRAP(mean) 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 eRAP(IVC), eRAPE/e ', eRAP(HV), and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from eRAPE/e ' and eRAP(HV) for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAP(mean) than for eRAP(IVC) at both 5-mmHg [0.64, 95% confidence interval (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 multiparametric eRAP(mean) does not provide advantage over eRAP(IVC), despite being more complex and time-consuming.