title: Echocardiographic Assessment of Right Atrial Pressure in a Pediatric and Young Adult Population.
abstract: Right atrial pressure (RAP) reflects right-sided cardiac hemodynamics and is useful in management of patients with cardiac and systemic disease. Studies in older adults demonstrated that inferior vena cava (IVC) diameter, IVC collapsibility index, hepatic vein systolic filling fraction (SFF), and right atrial volume (RAV) correlated with mean RAP at catheterization. This study aimed to assess the utility of echocardiographic parameters for assessment of RAP in children and young adults. Patients with pulmonary hypertension or heart transplantation undergoing right heart catheterization were recruited for this prospective observational pilot study. Transthoracic echocardiographic assessment of RAP was performed simultaneously with catheterization. For each parameter, three consecutive cardiac cycles were recorded. Long- and short-axis images of the IVC were obtained. RAV was assessed by area-length and biplane methods. IVC diameters and RAV were indexed to body surface area (BSA)(0.5) and (BSA)(1.4), respectively. Relationships between echocardiographic parameters and mean RAP were correlated using "Pearson's r." Fifty subjects aged 0.3-23 years (median 13, mean 12.3 ± 7 years) were enrolled. Mean RAP correlated modestly with RAV (r = 0.51, p < 0.001). Long-axis IVCmax (r = 0.30, p < 0.05) and tricuspid E wave velocity (r = 0.36, p < 0.01) also correlated with mean RAP. RV free wall tissue Doppler velocities, IVC collapsibility index, and hepatic vein SFF had no relation to mean RAP. In a pediatric and young adult population with pulmonary hypertension or heart transplantation, echocardiographic assessment of RAV and long-axis IVCmax provided a reasonable estimate of mean RAP. IVC collapsibility index and hepatic vein SFF demonstrated no association with mean RAP.
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, M/S RC.2.820, PO Box 5371, Seattle, WA, 98105, USA. bhawna.arya@seattlechildrens.org.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Arya
authors.affiliation: Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Kerstein
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Cheng-Shiun
authors.initials: CS
authors.lastname: Leu
authors.affiliation: Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Warren A
authors.initials: WA
authors.lastname: Zuckerman
authors.affiliation: Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Krishnan
authors.affiliation: Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
mesh_terms: D000293:Adolescent; D016280:Atrial Function, Right; D062185:Atrial Pressure; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007223:Infant; D016015:Logistic Models; D008297:Male; D009518:New York; D010865:Pilot Projects; D011446:Prospective Studies; D012372:ROC Curve; D014682:Vena Cava, Inferior / Q000503:physiopathology; D055815:Young Adult
keywords: Atrial volume; Echocardiography; Inferior vena cava; Pulmonary arterial hypertension; Right atrial pressure