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Relation of Right Atrial Volume, Systemic Venous Dimensions, and Flow Patterns to Right Atrial Pressure in Infants
Shivani G Patel1, Peter Woolman1, Ling Li1
1Division of Pediatric Cardiology, Children's Hospital and Medical Center, University of Nebraska College of Medicine, Creighton University School of Medicine, Omaha, Nebraska.
Insights
This study developed a noninvasive model to estimate right atrial pressure in children using echocardiography. The model combines inferior vena cava flow velocity and right atrial volume for accurate RA pressure assessment.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Hemodynamics
Background:
- Right atrial (RA) pressure in adults can be assessed invasively via catheterization.
- Echocardiographic parameters like RA volume, IVC diameter, and hepatic vein flow correlate with RA pressure in adults.
- Noninvasive methods for RA pressure assessment in pediatric populations are needed.
Purpose of the Study:
- To develop a predictive model for noninvasively determining normal right atrial pressure in infants and young children.
- To identify echocardiographic parameters that correlate with invasive RA pressure measurements in pediatric patients.
Main Methods:
- Prospective collection of invasive RA pressure measurements and echocardiographic data in pediatric patients with biventricular hearts, in sinus rhythm, without inotropes, and at least 24 hours post-surgery.
- Utilized 2D and 3D echocardiography (2DE and 3DE) Doppler to measure RA volume, systemic venous diameters, and flow velocities.
- Explored regression equations to correlate RA pressure with echocardiographic parameters, performing multivariable analysis.
Main Results:
- RA pressure did not correlate with age or body surface area.
- Inferior vena cava (IVC) systolic flow velocity and systolic 2D Simpson's derived indexed RA volume were independently correlated with RA pressure.
- Developed the equation: RA pressure (mm Hg) = 7.35 - 0.0025 × IVC systolic flow velocity (cm/s) + 0.119 × indexed RA volume by systolic 2D Simpson's (ml/m²).
- No correlation found between RA pressure and systemic venous diameters or SVC/hepatic vein flow velocities.
Conclusions:
- A regression model incorporating 2DE-derived RA volume and IVC systolic flow velocity offers the best noninvasive estimate of normal RA pressure in infants and children.
- The developed model requires validation in an independent cohort.
- This noninvasive approach could aid in pediatric cardiovascular assessment.
Abstract:
Echocardiographic assessment of right atrial (RA) volume, inferior vena cava (IVC) diameter, and hepatic vein flow velocity independently correlate with the RA pressure by direct catheter measurement in adults. We prospectively collected invasive RA pressure measurements and echocardiographic data in infants and young children with the goal of developing a predictive model to noninvasively determine normal RA pressure. All subjects had a central venous catheter through which RA pressure could be transduced. Specific inclusion criteria consisted of (1) biventricular heart, (2) absence of inotropes, (3) sinus rhythm, and (4) at least 24 hours from surgery. Two-dimensional echocardiography (2DE)-Doppler and 3DE-Doppler were used to measure RA volume, systemic venous diameters, and flow velocity. Regression equations of RA pressure with RA volume, systemic venous size, and flow velocity were explored. Of 46 studies, 43 (93%) had echocardiograms adequate for analysis. RA pressure did not correlate with body surface area or age (p = 0.69, p = 0.87). The mean indexed RA volume by 3DE-Doppler was significantly higher than by 2DE (p <0.005). On multivariable analysis, only IVC systolic flow velocity and systolic 2D Simpson's derived indexed RA volume demonstrated significant independent correlation with RA pressure, resulting in the equation: RA pressure (mm Hg) = 7.35 - 0.0025 × IVC systolic flow velocity (cm/s) + 0.119 × indexed RA volume by systolic 2D Simpson's (ml/m2). RA pressure did not show correlation with systemic venous diameters or systolic and diastolic flow velocities in the SVC and hepatic veins. In conclusion, regression incorporating 2DE-derived RA volume and IVC systolic flow velocity provided the best noninvasive estimate of normal RA pressure in infants and children. The model derived requires validation in an independent sample.
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