Non-invasive Estimation of Right Atrial Pressure Using Inferior Vena Cava Echography

Abstract

The pulsatility of the inferior vena cava (IVC) reflects the volume status and central venous pressure of patients. The standard clinical indicator of IVC pulsatility is the caval index (CI), measured from ultrasound recordings. However, its estimation is not standardized and is vulnerable to artifacts, mostly because of IVC movements during respiration. Thus, we used a (recently patented) semi-automated method that tracks IVC movements and averages the CI across an entire section of the vein, which provides a more stable indication of pulsatility. This algorithm was used to estimate the CI, pulsatility indicators reflecting either respiratory or cardiac stimulation and the mean diameter of the IVC. These IVC indices, together with anthropometric information, were used as potential features to build an innovative model for the estimation of the right atrial pressure (RAP) recorded from 49 catheterized patients. An exhaustive search was carried out for the best among all possible models that could be obtained by using combinations of these features. The model with minimum estimation error (tested with a leave-one-out approach) was selected. This model estimated RAP with an error of about 3.6 ± 2.6 mm Hg (mean ± standard deviation); the error when using only operator measured variables, without software, was about 4.0 ± 2.5 mm Hg. These promising results underline the need for further study of our RAP estimation method on a larger data set.