Value of conventional and tissue Doppler echocardiography in the noninvasive measurement of right atrial pressure.

BACKGROUND

Evaluation of right atrial pressure (RAP) provides useful diagnostic, therapeutic, and prognostic information.

AIM

To assess the utility of several conventional and tissue Doppler parameters in the estimation of RAP.

METHODS

Among 50 consecutive patients (median age: 50 years; all in sinus rhythm), invasively measured RAP was simultaneously correlated with pulsed Doppler of tricuspid inflow (peak E and A velocities, E-wave deceleration time) and pulsed tissue Doppler of lateral tricuspid annulus (peak E' and A' velocities, isovolumic relaxation time [IVRT], acceleration time and rate of E'-wave, deceleration time and rate of E'-wave). These ratios were calculated: E/A, E'/A', E/E', and E/IVRT.

RESULTS

The median RAP was 14 mmHg (range 1-27 mmHg) with 29 patients (58%) having an elevated RAP (>10 mmHg). Among all studied Doppler variables, E/E' ratio showed the strongest correlation with RAP (r = 0.84, P < 0.001) with the following regression equations: RAP = 1.24 + (1.69 × E/E'). The mean difference between Doppler and invasively measured RAP was 0.21 ± 2.6 mmHg. E/ E' ratio ≥ 4.5 provides 89% sensitivity and 100% specificity for detection of elevated RAP (receiver operating characteristic area 0.95; P < 0.001).

CONCLUSION

Of all echocardiographic variables investigated, tricuspid annular E/E' ratio is identified as the best index for noninvasive determination of RAP.