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Discriminatory ability of right atrial volumes with two- and three-dimensional echocardiography to detect elevated right atrial pressure in pulmonary hypertension

Ostenfeld, Ellen LU ; Werther-Evaldsson, Anna LU ; Engblom, Henrik LU ; Ingvarsson, Annika LU ; Roijer, Anders LU ; Meurling, Carl LU ; Holm, Johan LU ; Rådegran, Göran LU and Carlsson, Marcus LU (2016) In Clinical Physiology and Functional Imaging
Abstract

Aims: Pulmonary hypertension (PH) patients have high mortality due to right ventricular failure. Predictors of poor prognostic outcome are increased right atrial volume (RAV) and elevated mean right atrial pressure (mRAP). Our aim was to determine whether RAV measured with 2D echocardiography (2DE) and 3D echocardiography (3DE) can detect elevated mRAP in patients evaluated for PH. Methods: Of 85 patients prospectively evaluated for PH, 44 patients (63 ± 15 years, 57% female) had 2DE, 3DE and right heart catheterization within 48 h and were in sinus rhythm. Maximum (RAVmax) and minimum (RAVmin) volumes were measured with 3DE. 2D maximum RAV and RA area, inferior vena cava diameter and collapsibility were measured.... (More)

Aims: Pulmonary hypertension (PH) patients have high mortality due to right ventricular failure. Predictors of poor prognostic outcome are increased right atrial volume (RAV) and elevated mean right atrial pressure (mRAP). Our aim was to determine whether RAV measured with 2D echocardiography (2DE) and 3D echocardiography (3DE) can detect elevated mRAP in patients evaluated for PH. Methods: Of 85 patients prospectively evaluated for PH, 44 patients (63 ± 15 years, 57% female) had 2DE, 3DE and right heart catheterization within 48 h and were in sinus rhythm. Maximum (RAVmax) and minimum (RAVmin) volumes were measured with 3DE. 2D maximum RAV and RA area, inferior vena cava diameter and collapsibility were measured. Invasive mRAP > 8 mmHg was predefined as elevated. Results: RAVmax and RAVmin correlated with mRAP (r = 0·40 and r = 0·35, P<0·05, for both), and so did 2DE maximum RAV (r = 0·42, P = 0·005) and RA area (r = 0·40, P = 0·008). Area under the curve (AUC) from receiver-operating characteristics curves was for 3DE 0·77 for RAVmax, 0·74 for RAVmin, from 2DE, 0·76 for maximum RAV and 0·75 for RA area to discriminate elevated mRAP (P<0·01 for all). PH patients had larger 3D RAV compared with controls (P<0·01). IVC diameter correlated with mRAP (r = 0·41, P = 0·007), but collapsibility did not (P = 0·078). AUC was neither significant for IVC diameter nor for collapsibility for predicting mRAP>8 mmHg. The optimal threshold was 57 ml m-2 for RAVmax, 31 ml m-2 for RAVmin and 36 ml m-2 for 2DE RAV. Conclusions: Enlarged RA measures with 2DE and 3DE have better discriminatory ability compared with IVC measures, to detect elevated mRAP in patients evaluated for PH.

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organization
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Contribution to journal
publication status
epub
subject
keywords
Echocardiography, Inferior vena cava, Pulmonary hypertension, Right atrial pressure, Right atrial volume, Three-dimensional
in
Clinical Physiology and Functional Imaging
publisher
Wiley Online Library
external identifiers
  • scopus:85008254129
ISSN
1475-0961
DOI
10.1111/cpf.12398
language
English
LU publication?
yes
id
fdfe7e59-fde8-4fad-a894-2e8ceaaf8efc
date added to LUP
2017-01-19 11:41:32
date last changed
2017-06-15 11:38:00
@article{fdfe7e59-fde8-4fad-a894-2e8ceaaf8efc,
  abstract     = {<p>Aims: Pulmonary hypertension (PH) patients have high mortality due to right ventricular failure. Predictors of poor prognostic outcome are increased right atrial volume (RAV) and elevated mean right atrial pressure (mRAP). Our aim was to determine whether RAV measured with 2D echocardiography (2DE) and 3D echocardiography (3DE) can detect elevated mRAP in patients evaluated for PH. Methods: Of 85 patients prospectively evaluated for PH, 44 patients (63 ± 15 years, 57% female) had 2DE, 3DE and right heart catheterization within 48 h and were in sinus rhythm. Maximum (RAV<sub>max</sub>) and minimum (RAV<sub>min</sub>) volumes were measured with 3DE. 2D maximum RAV and RA area, inferior vena cava diameter and collapsibility were measured. Invasive mRAP &gt; 8 mmHg was predefined as elevated. Results: RAV<sub>max</sub> and RAV<sub>min</sub> correlated with mRAP (r = 0·40 and r = 0·35, P&lt;0·05, for both), and so did 2DE maximum RAV (r = 0·42, P = 0·005) and RA area (r = 0·40, P = 0·008). Area under the curve (AUC) from receiver-operating characteristics curves was for 3DE 0·77 for RAV<sub>max</sub>, 0·74 for RAV<sub>min</sub>, from 2DE, 0·76 for maximum RAV and 0·75 for RA area to discriminate elevated mRAP (P&lt;0·01 for all). PH patients had larger 3D RAV compared with controls (P&lt;0·01). IVC diameter correlated with mRAP (r = 0·41, P = 0·007), but collapsibility did not (P = 0·078). AUC was neither significant for IVC diameter nor for collapsibility for predicting mRAP&gt;8 mmHg. The optimal threshold was 57 ml m<sup>-2</sup> for RAV<sub>max</sub>, 31 ml m<sup>-2</sup> for RAV<sub>min</sub> and 36 ml m<sup>-2</sup> for 2DE RAV. Conclusions: Enlarged RA measures with 2DE and 3DE have better discriminatory ability compared with IVC measures, to detect elevated mRAP in patients evaluated for PH.</p>},
  author       = {Ostenfeld, Ellen and Werther-Evaldsson, Anna and Engblom, Henrik and Ingvarsson, Annika and Roijer, Anders and Meurling, Carl and Holm, Johan and Rådegran, Göran and Carlsson, Marcus},
  issn         = {1475-0961},
  keyword      = {Echocardiography,Inferior vena cava,Pulmonary hypertension,Right atrial pressure,Right atrial volume,Three-dimensional},
  language     = {eng},
  publisher    = {Wiley Online Library},
  series       = {Clinical Physiology and Functional Imaging},
  title        = {Discriminatory ability of right atrial volumes with two- and three-dimensional echocardiography to detect elevated right atrial pressure in pulmonary hypertension},
  url          = {http://dx.doi.org/10.1111/cpf.12398},
  year         = {2016},
}