Assessment of right atrial pressure with 2-dimensional and Doppler echocardiography: A simultaneous catheterization and echocardiographic study

Objective: To derive a clinically useful, noninvasive determination of righ t atrial pressure, Noninvasive assessment of right ventricular systolic pre ssure from Doppler-derived tricuspid regurgitant velocity requires an accur ate assumption of right atrial pressure. Patients and Methods: Seventy-one patients were studied in the cardiac cath eterization laboratory, comparing right atrial pressure (measured at mid sy stole) with simultaneous 2-dimensional echocardiographic measurement of inf erior vena cava diameter and Doppler recordings of hepatic vein systolic, d iastolic, and atrial reversal velocities. The initial 28 patients were used to derive a clinical algorithm to predict right atrial pressure, which was tested in the subsequent 43 patients. Results: Inferior vena cava dimension correlated directly with right atrial pressure (r(2)=0.74; P<.001). The systolic filling fraction of the hepatic vein velocity curves correlated poorly with right atrial pressure. However , the correlation between the hepatic vein Doppler sum of systolic forward flow velocity and atrial reversal velocity and right atrial pressure was in verse (r(2)=032; P=.002). With a combination of variables from both inferio r vena cava diameter and hepatic vein velocity curves, patients can be divi ded into those with normal right atrial pressure, mildly increased right at rial pressure, and severely increased right atrial pressure. Conclusion: The combined information from inferior vena cava diameter and h epatic vein velocity curves can be used to assess fight atrial pressure.