title: Echocardiographic assessment of estimated right atrial pressure and size predicts mortality in pulmonary arterial hypertension.
abstract: BACKGROUND
  Elevated mean right atrial pressure (RAP) measured by cardiac catheterization is an independent risk factor for mortality. Prior studies have demonstrated a modest correlation with invasive and noninvasive echocardiographic RAP, but the prognostic impact of estimated right atrial pressure (eRAP) has not been previously evaluated in patients with pulmonary arterial hypertension (PAH).
  
  
  METHODS
  A retrospective analysis of 121 consecutive patients with PAH based on right-sided heart catheterization and echocardiography was performed. The eRAP was calculated by inferior vena cava diameter and collapse using 2005 and 2010 American Society of Echocardiography (ASE) definitions. Accuracy and correlation of eRAP to RAP was assessed. Kaplan-Meier survival analysis by eRAP, right atrial area, and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry) risk criteria as well as univariate and multivariate analysis of echocardiographic findings was performed.
  
  
  RESULTS
  Elevation of eRAP was associated with decreased survival time compared with lower eRAP (P < .001, relative risk = 7.94 for eRAP > 15 mm Hg vs eRAP ≤ 5 mm Hg). Univariate analysis of echocardiographic parameters including eRAP > 15 mm Hg, right atrial area > 18 cm², presence of pericardial effusion, right ventricular fractional area change < 35%, and at least moderate tricuspid regurgitation was predictive of poor survival. However, multivariate analysis revealed that eRAP > 15 mm Hg was the only echocardiographic risk factor that was predictive of mortality (hazard ratio = 2.28, P = .037).
  
  
  CONCLUSIONS
  Elevation of eRAP by echocardiography at baseline assessment was strongly associated with increased risk of death or transplant in patients with PAH. This measurement may represent an important prognostic component in the comprehensive echocardiographic evaluation of PAH.
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Christopher
authors.initials: C
authors.lastname: Austin
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Khadija
authors.initials: K
authors.lastname: Alassas
authors.affiliation: Division of Pulmonary Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Charles
authors.initials: C
authors.lastname: Burger
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Robert
authors.initials: R
authors.lastname: Safford
authors.affiliation: Division of Internal Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pagan
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Katherine
authors.initials: K
authors.lastname: Duello
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Preetham
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Division of Pulmonary Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.
authors.forename: Tonya
authors.initials: T
authors.lastname: Zeiger
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.. Electronic address: shapiro.brian@mayo.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Shapiro
mesh_terms: D016280:Atrial Function, Right / Q000502:physiology*; D062185:Atrial Pressure / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors