Related Experiment Video
Updated: Nov 11, 2025
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Multiparametric vs. Inferior Vena Cava-Based Estimation of Right Atrial Pressure
Matteo Toma1,2, Stefano Giovinazzo1, Gabriele Crimi1
1Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.
Insights
The mean of multiple echocardiographic estimates for right atrial pressure (RAP) did not improve accuracy over single inferior vena cava assessments. Combining methods for eRAPmean is more complex without clear benefits over eRAPIVC.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Right atrial pressure (RAP) is crucial for cardiovascular assessment.
- Echocardiography offers non-invasive estimation methods: inferior vena cava (eRAPIVC), tricuspid E/e' ratio, and hepatic vein flow (eRAPHV).
- Combining these estimates into a mean (eRAPmean) may enhance accuracy.
Purpose of the Study:
- To evaluate if a multiparametric mean estimate of right atrial pressure (eRAPmean) is more accurate than single echocardiographic methods.
- To compare the accuracy of eRAPmean and individual echocardiographic estimates against invasive RAP (iRAP).
Main Methods:
- 43 patients undergoing right heart catheterization had RAP measured invasively (iRAP) and estimated non-invasively using eRAPIVC, E/e', eRAPHV, and eRAPmean.
- Statistical analyses included Spearman correlation, Bland-Altman agreement, Wilcoxon signed-rank test, and AUC for predictive accuracy.
- eRAPHV was categorized into 5, 10, 15, or 20 mmHg; eRAPmean was continuous.
Main Results:
- eRAPmean showed a positive correlation with iRAP (r=0.66, P<0.001), with best agreement below 10 mmHg.
- Concordance between individual echocardiographic estimates and iRAP tended to decrease across pressure categories (5-20 mmHg).
- eRAPmean did not significantly outperform eRAPIVC in predicting iRAP at 5-mmHg and 10-mmHg thresholds (AUC comparison P>0.4).
Conclusions:
- Multiparametric estimation of right atrial pressure (eRAPmean) does not offer a significant advantage over the simpler eRAPIVC method.
- The increased complexity and time required for eRAPmean may outweigh its marginal benefits.
- eRAPIVC remains a valuable and potentially more practical echocardiographic tool for RAP estimation.
Abstract:
Background: Right atrial pressure (RAP) can be estimated by echocardiography from inferior vena cava diameter and collapsibility (eRAPIVC), tricuspid E/e' ratio ( ), or hepatic vein flow (eRAPHV). The mean of these estimates (eRAPmean) might be more accurate than single assessments. Methods and Results: eRAPIVC, , eRAPHV (categorized in 5, 10, 15, or 20 mmHg), eRAPmean (continuous values) and invasive RAP (iRAP) were obtained in 43 consecutive patients undergoing right heart catheterization [median age 69 (58-75) years, 49% males]. There was a positive correlation between eRAPmean and iRAP (Spearman test r = 0.66, P < 0.001), with Bland-Altman test showing the best agreement for values <10 mmHg. There was also a trend for decreased concordance between eRAPIVC, , eRAPHV, and iRAP across the 5- to 20-mmHg categories, and iRAP was significantly different from and eRAPHV for the 20-mmHg category (Wilcoxon signed-rank test P = 0.02 and P < 0.001, respectively). The areas under the curve in predicting iRAP were nonsignificantly better for eRAPmean than for eRAPIVC at both 5-mmHg [0.64, 95% confidence interval (CI) 0.49-0.80 vs. 0.70, 95% CI 0.53-0.87; Wald test P = 0.41] and 10-mmHg (0.76, 95% CI 0.60-0.92 vs. 0.81, 95% CI 0.67-0.96; P = 0.43) thresholds. Conclusions: Our data suggest that multiparametric eRAPmean does not provide advantage over eRAPIVC, despite being more complex and time-consuming.
