Journal of the American Society of Echocardiography
Clinical InvestigationEchocardiographic Parameters Associated with Outcomes in Various DiseasesRight Atrial Pressure Is Associated with Outcomes in Patients with Heart Failure and Indeterminate Left Ventricular Filling Pressure
Section snippets
Population
A cohort of 598 consecutive adult patients admitted to our hospital who underwent echocardiography for suspected HF from January 2016 to December 2017 was evaluated. At hospital discharge, 496 patients had confirmed diagnoses of HF and were considered for the study (diagnoses not confirmed as HF were pulmonary embolism in 42 patients, chronic obstructive pulmonary disease exacerbation in 29 patients, pneumonia and sepsis in 26 patients, and cardiac tamponade in five patients). At the time of
Patient Characteristics
Patient characteristics are reported in Supplemental Table 1 for the overall cohort and subgroups of patients with LVEFs < 50% and ≥50%. Patients with different LVEFs differed on a number of variables. Patients with LVEFs < 50% had more ischemic etiology and coronary artery disease and less arterial hypertension, higher levels of NatPs, higher heart rates at admission and during transthoracic echocardiography, higher LV end-diastolic volume and end-systolic volume, lower SVI and cardiac index,
Discussion
Our study shows that the noninvasive estimation of mRAP using echocardiography may help stratify prognosis in the subset of patients with IP, whereas it does not do so in patients with current guideline-determined LVFP. In addition, reclassification of patients with IP according to noninvasive mRAP estimation allows a net prognostic distinction between patients with HF with NP and HP, with the latter having worse outcomes.
Conclusion
When guideline-recommended estimation of LVFP is inconclusive, echocardiographic estimation of RAP as a surrogate marker of LVFP can predict outcomes and therefore may be incorporated in the algorithm for estimating LVFP.
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Cited by (8)
Noninvasive Hemodynamic Evaluation at Rest in Heart Failure with Preserved Ejection Fraction
2021, Heart Failure ClinicsCitation Excerpt :In these patients it might be useful to assess the mean RA pressure, which is estimated with reasonable accuracy through tissue Doppler imaging by using early tricuspid inflow velocity in relation to the lateral RV annulus myocardial velocity (E/e’ for RV).38 Mele and colleagues39 have suggested to reclassify these patients based on the mean RA pressure, because they show this measure is associated with outcome in hospitalized HF patients with in indeterminate LA pressure, but not in patients with normal or increased LA pressure. Recently, a meta-analysis sought to investigate the evidence behind the diastolic parameters recommended in currents guidelines, and they showed that E/e’ was most established, but contrary to previous reports, the relationship with fillings pressures was only shown to be modest.40
New measures of right ventricle-pulmonary artery coupling in heart failure: An all-cause mortality echocardiographic study
2021, International Journal of CardiologyCitation Excerpt :In addition, current guidelines on diastolic dysfunction have adopted TRV as a marker for assessing elevated left ventricular filling pressure [16]. It should be also recognized that in 10% of patients RAP cannot be estimated because of inadequate visualization of IVC [13,14]. Thus, an alternative measure of RVPAC which indexes TAPSE for TRV may be useful in clinical practice.
Use of Real-Time Cine MRI to Assess the Respirophasic Variation of the Inferior Vena Cava—Proof-of-Concept and Validation Against Transthoracic Echocardiography
2024, Journal of Magnetic Resonance ImagingCombining echo-derived haemodynamic phenotypes and myocardial strain for risk stratification of chronic heart failure with reduced ejection fraction
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Conflicts of Interest: None.