Echocardiographic RV-E/e' for predicting right atrial pressure: a review.

Area of Science:

• Cardiology
• Cardiac Physiology
• Echocardiography

Background:

• Right atrial pressure (RAP) is crucial for assessing cardiac function but difficult to measure accurately with current echocardiography.
• Existing 2D echocardiographic methods for RAP estimation are inadequate.
• Accurate RAP measurement is vital for diagnosis and prognosis.

Purpose of the Study:

• To systematically review the literature comparing invasively measured RAP with echocardiographically estimated RAP using the right ventricular (RV) E/e' ratio.
• To evaluate the diagnostic accuracy and precision of the RV E/e' ratio as a surrogate for RAP.
• To identify limitations and areas for future research regarding RV E/e' for RAP estimation.

Main Methods:

• A systematic literature search was conducted to identify studies comparing invasive RAP with RV E/e' estimated RAP.
• Seventeen relevant articles were included in the review.
• Statistical analyses included receiver operating characteristic (ROC) and Bland-Altman analyses.

Main Results:

• The RV E/e' ratio showed reasonable diagnostic ability for RAP in coronary artery disease and RV systolic dysfunction.
• Diagnostic ability was poor in pediatrics, heart failure, and mitral stenosis, and equivocal in other conditions.
• Bland-Altman analyses indicated good accuracy but poor precision for individual RAP estimation.

Conclusions:

• The RV E/e' ratio may be useful for estimating RAP at a population level but not for individual clinical decision-making.
• Evidence regarding the impact of atrial fibrillation and the prognostic ability of RV E/e' is limited.
• Future research should focus on non-sinus rhythms, valvular heart disease, and prognostic capabilities.