SPC365

Right atrial pressure estimation by echocardiography in pulmonary hypertension – time for a change?

Session: SESSÃO DE POSTERS 14 - CONGÉNITOS E HTP 2
Speaker: Fábio Viveiros

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.3 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Diagnostic Methods
Session Type: Cartazes
FP Number: ---
Authors: Fabio Viveiros; Catarina Gregório; Miguel Azaredo Raposo; Ana Abrantes; Daniel Cazeiro; Inês Caldeira Araújo; Susana Gonçalves; Ana Almeida; Catarina Sousa; Fausto J. Pinto; Rui Plácido

<p style="margin-left:6px"><span style="font-size:10.947052955627441pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction&nbsp;</strong></span></span></span></p>

<p style="margin-left:6px; margin-right:29px"><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Right atrial pressure (RAP) is a valuable measurement for assessing hemodynamic status in pulmonary hypertension (PH) patients (pts). Correct estimation of RAP (eRAP) and management of fluid status is crucial in this challenging population. The current ESC PH guidelines classify RAP estimation into three subgroups based on inferior vena cava (IVC) diameter and inspiratory collapse.&nbsp;</span></span></span></p>

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<p style="margin-left:5px"><span style="font-size:10.947052955627441pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Aim:&nbsp;</strong></span></span></span><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate the correlation between standard eRAP and invasive measurement in right heart catheterization (RHC).&nbsp;</span></span></span></p>

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<p style="margin-left:6px"><span style="font-size:10.947052955627441pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods&nbsp;</strong></span></span></span></p>

<p style="margin-left:5px; margin-right:10px"><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This is a retrospective, single-center study of consecutive patients diagnosed with PH, who underwent RHC and transthoracic echocardiography on the same day. RAP was estimated according to the guidelines at 3, 8, and 15mmHg, and using a modified 4-level method at 5, 10, 15, and 20 mmHg. Hemodynamic parameters were recorded from RHC. Statistical analysis was conducted using Pearson&#39;s and Spearman&#39;s correlations, and Cohen&#39;s Kappa was used to assess agreement between invasive measurements and the standard and modified eRAP groups by echo.&nbsp;</span></span></span></p>

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<p style="margin-left:6px"><span style="font-size:10.947052955627441pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results&nbsp;</strong></span></span></span></p>

<p style="margin-left:5px; margin-right:9px"><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 69 patients were included in the study, with a majority being female (64%) and a mean age of 63.7 years. The distribution of PH subgroups was as follows: Group I (43%), Group II (10%), Group III (12%), and Group IV (30%). The mean RAP measured from RHC was 7.59 mmHg, compared to 7.69 mmHg estimated by echo using the standard method. There was a significant positive correlation between RAP and eRAP (p&lt;0.001), albeit not strong (r=0.439). The modified 4-level method did not show any advantage. Inferior vena&nbsp;</span></span></span><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">cava (IVC) diameter showed a significant positive correlation with RAP (r=0.571, p&lt;0.001). When RAP was divided into three groups (&lt;5 mmHg, &gt;5 &lt;10 mmHg, and &gt;10 mmHg), the agreement assessed with Cohen&#39;s Kappa was statistically significant (p=0.008), but minimal with a kappa of 0.235. When RAP was divided into four groups (&lt;5 mmHg, &gt;5 &lt;10 mmHg, &gt;10 &lt;15 mmHg, and &gt;15 mmHg), the agreement assessed with Cohen&#39;s Kappa was statistically significant (p=0.022), with a lower kappa of 0.169.&nbsp;</span></span></span></p>

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<p style="margin-left:6px"><span style="font-size:10.947052955627441pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusions&nbsp;</strong></span></span></span></p>

<p style="margin-left:5px"><span style="font-size:10.947052955627441pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The standard eRAP pressure through echocardiography using IVC diameter and inspiratory collapse showed a weak but significant correlation with invasive measurements. Subdividing into four groups did not improve the agreement between estimated and actual RAP measurements. Imperfect evaluation of IVC collapsibility may contribute to these findings. A more accurate tool for estimating RAP in PH patients is needed.</span></span></span></p>

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