Methodist DeBakey Heart and Vascular Center, Houston, Texas.
University of Oslo, Oslo, Norway.
J Am Soc Echocardiogr. 2018 Jul;31(7):799-806. doi: 10.1016/j.echo.2018.01.025. Epub 2018 Mar 24.
There is a paucity of data on the utility of right atrial pressure (RAP) for estimating pulmonary capillary wedge pressure (PCWP) in patients with normal ejection fraction (EF), including patients with heart failure with preserved EF.
Mean RAP was compared with PCWP in 129 patients (mean age, 61 ± 11 years; 45% men) with exertional dyspnea enrolled in a multicenter study. Measurements included left ventricular volumes, EF, and mitral inflow velocities.
Mean PCWP was 14 ± 7 mm Hg, and mean RAP was 8 ± 5 mm Hg. A significant relation was present between mean RAP and mean PCWP (r = 0.5, P < .001). RAP > 8 mm Hg had 76% sensitivity and 86% specificity in detecting mean PCWP > 12 mm Hg. In 101 patients with inconclusive mitral filling pattern (defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 diastolic function recommendations), RAP by catheterization had sensitivity of 73% and specificity of 91%. In a subset of 59 patients with echocardiographic assessment of mean RAP, RAP by echocardiography had sensitivity of 76% and specificity of 89%.
Mean RAP provides useful information about mean PCWP in many patients with normal left ventricular EF. There is good sensitivity and excellent specificity when combining invasive or noninvasive RAP and mitral velocities to determine if PCWP is elevated.
在射血分数正常的患者（包括射血分数保留的心力衰竭患者）中，右心房压（RAP）用于估计肺毛细血管楔压（PCWP）的实用性数据很少。
在一项多中心研究中，对 129 名因劳力性呼吸困难而就诊的患者（平均年龄 61 ± 11 岁，45%为男性）进行平均 RAP 与 PCWP 的比较。测量包括左心室容积、射血分数和二尖瓣血流速度。
平均 PCWP 为 14 ± 7 mmHg，平均 RAP 为 8 ± 5 mmHg。平均 RAP 与平均 PCWP 之间存在显著相关性（r = 0.5，P <.001）。RAP > 8 mmHg 时，检测平均 PCWP > 12 mmHg 的敏感性为 76%，特异性为 86%。在 101 名二尖瓣充盈模式不确定的患者（根据美国超声心动图学会/欧洲心血管成像协会 2016 年舒张功能建议定义）中，导管插入术的 RAP 敏感性为 73%，特异性为 91%。在 59 名具有平均 RAP 超声心动图评估的患者亚组中，超声心动图的 RAP 敏感性为 76%，特异性为 89%。
在许多左心室射血分数正常的患者中，平均 RAP 可提供有关平均 PCWP 的有用信息。当结合有创或无创 RAP 和二尖瓣速度来确定 PCWP 是否升高时，其具有良好的敏感性和优异的特异性。
