Doppler-derived acceleration rate of right ventricular early filling reliably predicts mean right atrial pressure at baseline and after loading manipulations in patients with chronic heart failure.
BACKGROUND
We investigated whether Doppler-derived variables of tricuspid flow could estimate mean right atrial pressure and monitor its changes after loading manipulations in patients with chronic heart failure.


METHODS
Simultaneous mean right atrial pressure (Swan-Ganz catheterization) and tricuspid Doppler recordings were initially evaluated in 136 patients (23 with atrial fibrillation) with chronic heart failure and severe left ventricular systolic dysfunction, and then were repeated in 18 patients after unloading (sodium nitroprusside infusion) and in 13 patients after overloading (active leg elevation) manipulations.


RESULTS
A significant correlation was observed between mean right atrial pressure and peak E velocity (r = 0.70), early deceleration time (r = -0.72) and acceleration time (r = -0.75). However, the best correlation found was between the acceleration rate of early flow and mean right atrial pressure, and it was identical in patients in sinus rhythm or with atrial fibrillation (r = 0.98). Moreover, after acute effective unloading or overloading manipulations, although all Doppler tricuspid variables changed significantly, the acceleration rate of early flow still emerged as the strongest independent predictor of mean right atrial pressure (r = 0.95 and 0.99, respectively).


CONCLUSIONS
Doppler-derived acceleration rate of early diastolic tricuspid flow is a powerful tool to predict mean right atrial pressure and to monitor its changes after loading manipulations.
Scapellato
F
F
Division of Cardiology, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Medical Center of Rehabilitation, Veruno, Italy. cdl@intercom.it
Temporelli
P L
PL
Corrà
U
U
Eleuteri
E
E
Bosimini
E
E
Giannuzzi
P
P
D000328:Adult; D000368:Aged; D016280:Atrial Function, Right / Q000502:physiology*; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*