right atrial pressure
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2021 ◽  
Vol 8 ◽  
Author(s):  
Daisuke Harada ◽  
Hidetsugu Asanoi ◽  
Takahisa Noto ◽  
Junya Takagawa

Background: Influence of right ventricular diastolic function on the hemodynamics of heart failure (HF). We aimed to clarify the hemodynamic features of deep Y descent in the right atrial pressure waveform in patients with HF and preserved left ventricular systolic function.Methods: In total, 114 consecutive inpatients with HF who had preserved left ventricular systolic function (left ventricular ejection fraction ≥ 50%) and right heart catheterization were retrospectively enrolled in this study. The patients were divided into two groups according to right atrial pressure waveform, and those with Y descent deeper than X descent in the right atrial pressure waveform were assigned to the deep Y descent group. We enrolled another seven patients (two men, five women; mean age, 87 ± 6) with HF and preserved ejection fraction, and implanted a pacemaker to validate the results of this study.Results: The patients with deep Y descent had a higher rate of atrial fibrillation, higher right atrial pressure and mean pulmonary arterial pressure, and lower stroke volume and cardiac index than those with normal Y descent (76 vs. 7% p < 0.001, median 8 vs. 5 mmHg p = 0.001, median 24 vs. 21 mmHg p = 0.036, median 33 vs. 43 ml/m2p < 0.001, median 2.2 vs. 2.7 L/m2, p < 0.001). Multiple linear regression revealed a negative correlation between stroke volume index and pulmonary vascular resistance index (wood unit*m2) only in the patients with deep Y descent (estimated regression coefficient: −1.281, p = 0.022). A positive correlation was also observed between cardiac index and heart rate in this group (r = 0.321, p = 0.038). In the other seven patients, increasing the heart rate (from median 60 to 80/min, p = 0.001) significantly reduced the level of BNP (from median 419 to 335 pg/ml, p = 0.005).Conclusions: The hemodynamics of patients with HF with deep Y descent and preserved left ventricular systolic function resembled right ventricular restrictive physiology. Optimizing the heart rate may improve hemodynamics in these patients.


Author(s):  
Michael Bernhard Pitton ◽  
Arndt Weinmann ◽  
Roman Kloeckner ◽  
Jens Mittler ◽  
Christian Ruckes ◽  
...  

Abstract Purpose Porto-systemic pressure gradient is used to prognosticate rebleeding and resolution of ascites after TIPS. This study investigates the reliability of portal pressure characteristics as quantified immediately after TIPS placement and at short-term control. Patients and Methods Portal venous pressure (PVP) and right atrial pressure (RAP) were prospectively obtained before and after TIPS as well as ≥ 48 h after TIPS procedure. Porto-systemic pressure gradients (PSG) and pressure changes were calculated. A multivariate regression analysis was performed to predict portal hemodynamics at short-term control. Results The study included 124 consecutive patients. Indications for TIPS were refractory ascites, variceal bleeding or combinations of both. Pre- and post-interventional PSG yielded 16.4 ± 5.3 mmHg and 5.9 ± 2.7 mmHg, respectively. At that time, 105/124 patients (84.7%) met the target (PSG ≤ 8 mmHg). After 4 days (median), PSG was 8.5 ± 3.5 mmHg and only 66 patients (53%) met that target. In patients exceeding the target PSG at follow-up, PVP was significantly higher and RAP was lower resulting in the increased PSG. The highly variable changes of RAP were the main contributor to different pressure gradients. In the multivariate regression analysis, PVP and RAP immediately after TIPS were predictors for PSG at short-term control with moderately predictive capacity (AUC = 0.75). Conclusion Besides the reduction of portal vein pressure, the highly variable right atrial pressure was the main contributor to different pressure gradients. Thus, immediate post-TIPS measurements do not reliably predict portal hemodynamics during follow-up. These findings need to be further investigated with respect to the corresponding clinical course of the patients.


Author(s):  
GÜNDÜZALP SAYDAM ◽  
Ali Kilinc ◽  
Veysel Tosun ◽  
Necmettin Korucuk ◽  
Unal Guntekin ◽  
...  

Objective: According to Bernoulli Equation, systolic pulmonary artery pressure is obtained echocardiographically by adding estimated right atrial pressure (RAP) to the multiply of square of tricuspid regurgitation flow rate by four. RAP is estimated based on inferior vena cava (IVC) diameter and collapse. Our objective is to investigate usability of coronary sinus(CS) diameter and collapse, measured by echocardiography for estimating RAP. Methods: Our study is a single center, prospective study. 136 patients, over 18 years of age and without exclusion criteria, who admitted to Akdeniz University Hospital Cardiology Department between March 2017 and March 2018 and were scheduled to undergo right heart catheterization for any reason were included study. Results: Patients were divided into two groups as invasively measured RAP ≥10 mmHg (n: 57) and RAP <10 mmHg (n: 79). In group with RAP ≥10 mmHg, maximum IVC and CS diameter were higher than group with RAP <10 mmHg, IVC and CS collapse indices were lower (p <0.001). Optimal cut-off value for maximum IVC diameter was 19.6 mm (sensitivity 63.2%, specificity 87.3%), for IVC collapse index was 46.1 (sensitivity 75%, specificity 79.7%), for maximum CS diameter was 11 mm (sensitivity 64.9%, specificity 77%), for CS collapse index was 39.2 (sensitivity 75.4%, specificity 88.6%). Conclusion: Significant relationship was found between invasively measured RAP and maximum IVC diameter, collapse index and maximum CS diameter and collapse index. Results of CS parameters were as significant as results of IVC parameters therefore it shows that CS can also be used for estimating RAP.


2021 ◽  
Author(s):  
Marzieh Mirtajaddini ◽  
Nasim Naderi ◽  
Maryam Chenaghlou ◽  
Sepideh Taghavi ◽  
Ahmad Amin

Author(s):  
Alva Bjorkman ◽  
Lars H. Lund ◽  
Ulrika Faxen ◽  
Per Lindqvist ◽  
Ashwin Venkateshvaran

BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAP) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAP in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRV). METHODS. PAP was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAP were assessed. Diagnostic performance of DE methods vs. TRV=2.8m/sec to identify invasive PAP ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAP, with relatively lower mean bias and higher precision observed in algorithms that included TRV or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRV (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAP demonstrate reasonable accuracy to represent invasive PAP and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRV. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.


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