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Estimation of Right Atrial Pressure Using a Portable Handheld Ultrasound Device
Mohammed Elzeneini1, Shishir Gupta2, Yujia Li3
1Division of Cardiovascular Medicine, University of Florida, Gainesville.
Insights
Handheld ultrasound accurately estimates right atrial pressure (RAP) at the bedside. This portable tool shows strong correlation with invasive measurements, proving useful for clinical assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Point-of-Care Diagnostics
Background:
- Handheld ultrasound devices offer portability and ease of use in clinical settings.
- The efficacy of handheld ultrasound for estimating right atrial pressure (RAP) requires further investigation.
Purpose of the Study:
- To evaluate the accuracy of handheld ultrasound in estimating RAP.
- To compare ultrasound-derived RAP with invasive measurements from right heart catheterization (RHC).
Main Methods:
- Prospective study of 50 patients undergoing RHC.
- Handheld ultrasound used to measure inferior vena cava (IVC) and estimate RAP.
- Spearman's correlation and linear regression analyzed associations between estimated and invasive RAP.
Main Results:
- A significant correlation (r=0.80) was found between ultrasound-estimated RAP and invasive RAP.
- Correlation was stronger in heart failure patients (r=0.88).
- High sensitivity and specificity observed for predicting invasive RAP levels.
Conclusions:
- Handheld ultrasonography is a valuable tool for accurate bedside estimation of RAP.
- Portable ultrasound devices can reliably supplement invasive hemodynamic monitoring.
Background:
Handheld ultrasound devices are increasingly used by clinicians for their ease of use and portability. Their utility for estimating right atrial pressure (RAP) is poorly described.
Methods:
This prospective study enrolled 50 consecutive patients presenting for outpatient right heart catheterization (RHC). A handheld ultrasound device was used to measure inferior vena cava size and collapsibility and estimate RAP to be 3, 8, or 15 mmHg according to American Society of Echocardiography recommendations for cardiac chamber quantification. Invasive pressure measurements were then performed using RHC. Spearman's correlation and linear regression analysis were used to evaluate the association between estimated RAP using ultrasound and invasive RAP.
Results:
Fifty patients were enrolled (mean age 68 ± 8 years). Estimated RAP by ultrasound was significantly associated with invasive RAP (r 0.80; R2 0.63; 95% confidence interval, 0.61-0.96; P < .001). The correlation was stronger when RHC was indicated for evaluation of heart failure (r 0.88; P < .001) compared with other indications (r 0.69; P < .001). An estimated RAP of 3, 8, and 15 mmHg by ultrasound had a sensitivity and specificity of predicting an invasive RAP of 0-5, 6-10, and > 10 mmHg of 88% and 76%, 56% and 88%, and 81% and 97%, respectively, with overall accuracy of 80%, 76%, and 92%, respectively. Estimated RAP also correlated with invasive pulmonary capillary wedge pressure (r 0.64; R2 0.41; 95% confidence interval, 0.26-0.54; P < .001).
Conclusions:
Handheld ultrasonography is a useful tool that can accurately estimate RAP at the bedside.
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