[The noninvasive estimation of right atrial pressure improves the Doppler evaluation of the pulmonary systolic pressure].
The right ventricular systolic pressure can be evaluated with the Doppler method through the right ventricular-atrial gradient (RV-RA gradient) and the right atrial pressure. The former is expressed by the transtricuspid velocity of flow, the latter is generally assumed. In 50 patients with elevated pulmonary pressure we tested whether ultrasounds may be utilized for the evaluation of the right atrial pressure, and whether the derived values contribute to improve the accuracy of the method. We estimated the right ventricular systolic pressure with method A: RV-RA gradient + 10; and method B: RV-RA gradient x 1.1 + 14, where 10 and 14 are the assumed right atrial pressure (mmHg). Through the collapsibility index of the inferior vena cava, taken as an ultrasound-derived index of right atrial pressure, we were able to identify 3 groups of patients with normal (Group 1, 14 cases), elevated (Group 2, 21 cases) and moderately elevated (Group 3, 15 cases) right atrial pressure, respectively. In them the right ventricular systolic pressures obtained with both method A and method B were compared to those derived with catheter. In Group 1 the non-invasive values were significantly closer to the invasive ones when calculated with method A; the same was true of method B in Group 2. In Group 3 the accuracy of the 2 methods was similar. We conclude that ultrasound assists in the non-invasive approximation of the right atrial pressure as well as in the choice of the appropriate formula, so that Doppler estimation of the right ventricular systolic pressure is improved.
Pepi
M
M
Istituto di Cardiologia, Università degli Studi, Milano.
Tamborini
G
G
Sganzerla
P
P
Moruzzi
P
P
Galli
C
C
Fiorentini
C
C
Guazzi
M D
MD
D000328:Adult; D000368:Aged; D016275:Atrial Function; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D006328:Cardiac Catheterization; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D013599:Systole
La stima non invasiva della pressione atriale destra migliora la valutazione Doppler della pressione sistolica polmonare.