Right atrial pressure is under estimated by echocardiography in HFpEF patients

Abstract

The estimation of right atrial pressure (RAP) is important for pulmonary pressure and right ventricular filling pressure estimation. The accuracy of the inferior vena cava study to evaluate RAP has been tested in a few studies, and never in patients with heart failure with preserved ejection fraction (HFpEF) Our study investigated whether the study of inferior vena cava (IVC) size and collapsibility was accurate in a cohort of patients with heart failure with preserved ejection fraction (HFpEF). Between January 2014 and December 2018, 142 patients with suspected HFpEF and pulmonary hypertension (PH), underwent right heart catheterization (RHC) and transthoracic echocardiography within 5 days in our referral centre. The estimating RAP according to IVC size and collapsibility were retrospectively determined. Patients were classified in 3 groups according to the current guidelines: ≤ 2.1 cm that collapses > 50% with a sniff suggested a normal RAP of 3 mm Hg, an IVC diameter > 2.1 cm that collapses < 50% with a sniff suggested a high RAP of 15 mm Hg. A RAP of 8 mmHg was suggested for the other patients. A total of 118 patients (83%) had a possible and complete IVC analysis. Mean RAP estimation by right heart catheterism was 13 ± 5 mmHg. Inferior vena cava at end expiration was 19 ± 7 mm. Thirty-eight patients had an echo estimate RAP of 3 mmHg, whereas hemodynamic RAP in this group was 10 ± 5 mmHg. Forty patients had an echo estimate RAP of 8 mmHg, whereas hemodynamic RAP in this group was 14 ± 5 mmHg. 37 patients had an echo estimate RAP of 15 mmHg, whereas hemodynamic RAP in this group was 17 ± 5 mmHg. The RAP difference estimation of echo and hemodynamics was > 5 mmHg in respectively 66%, 40% and 39% of the patients in each group ( Fig. 1 ). In HFpEF patients, RAP is high. The study of the IVC is feasible in most cases but the estimation of the RAP is hazardous. This could have consequence in the evaluation of pulmonary pressure.