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Background: Assessment of the inferior vena cava (IVC) size by transthoracic echocardiography (TTE) is a standard tool for noninvasive estimation of right atrial pressure (RAP). However, there is limited data on its performance in known structural heart disease, when significant elevation of RAP might occur.
Methods: Imaging of IVC by TTE was performed during right heart catheterization in 35 patients with structural heart disease referred for invasive hemodynamic evaluation. Patients were categorized based on measured RAP into: normal RAP (≤7), mild-to-moderate (7<RAP≤15) and severe RAP elevation (>15 mmHg). Noninvasive assessment of RAP was done based on IVC collapsibility index according to the American Society of Echocardiography guidelines (3, 8 or 15 mmHg).
Results: Mean age was 64.2 ± 13 years and 13 patients were females (37%). Etiologies were valvular in 20 patients (57%), myopathic in 9 (25%) and other in 6 (17%). Mean RAP by catheterization was 13 ± 8 mmHg and mean RAP by TTE was 10 ± 4 mmHg; r2=0.66 (p<0.0001). Mean difference between estimated and measured RAP in normal RAP was 1 ± 3 mmHg; −2 ± 4 mmHg in mild-to-moderate elevation of RAP, and −8 ± 4 mmHg in severe RAP elevation (p<0.0001).
Conclusions: Noninvasive assessment markedly underestimated RAP in patients with structural heart disease and severely elevated RAP. Clinicians and echocardiographers should be aware of potential implications of these findings when calculating/estimating right ventricular systolic pressure in these patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights From Echocardiography Use
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1291-227
- 2017 American College of Cardiology Foundation