title: Discriminatory ability of right atrial volumes with two- and three-dimensional echocardiography to detect elevated right atrial pressure in pulmonary hypertension.
abstract: OBJECTIVE
  Pulmonary hypertension (PH) patients have high mortality due to right ventricular failure. Predictors of poor prognostic outcome are increased right atrial volume (RAV) and elevated mean right atrial pressure (mRAP). Our aim was to determine whether RAV measured with 2D echocardiography (2DE) and 3D echocardiography (3DE) can detect elevated mRAP in patients evaluated for PH.
  
  
  METHODS
  Of 85 patients prospectively evaluated for PH, 44 patients (63 ± 15 years, 57% female) had 2DE, 3DE and right heart catheterization within 48 h and were in sinus rhythm. Maximum (RAVmax) and minimum (RAVmin) volumes were measured with 3DE. 2D maximum RAV and RA area, inferior vena cava diameter and collapsibility were measured. Invasive mRAP > 8 mmHg was predefined as elevated.
  
  
  RESULTS
  RAVmaxand RAVmincorrelated with mRAP (r = 0·40 and r = 0·35, P<0·05, for both), and so did 2DE maximum RAV (r = 0·42, P = 0·005) and RA area (r = 0·40, P = 0·008). Area under the curve (AUC) from receiver-operating characteristics curves was for 3DE 0·77 for RAVmax, 0·74 for RAVmin, from 2DE, 0·76 for maximum RAV and 0·75 for RA area to discriminate elevated mRAP (P<0·01 for all). PH patients had larger 3D RAV compared with controls (P<0·01). IVC diameter correlated with mRAP (r = 0·41, P = 0·007), but collapsibility did not (P = 0·078). AUC was neither significant for IVC diameter nor for collapsibility for predicting mRAP>8 mmHg. The optimal threshold was 57 ml m-2for RAVmax, 31 ml m-2for RAVminand 36 ml m-2for 2DE RAV.
  
  
  CONCLUSIONS
  Enlarged RA measures with 2DE and 3DE have better discriminatory ability compared with IVC measures, to detect elevated mRAP in patients evaluated for PH.
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Ellen
authors.identifier: http://orcid.org/0000-0002-2655-2423
authors.initials: E
authors.lastname: Ostenfeld
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Werther-Evaldsson
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Ingvarsson
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Roijer
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Meurling
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Holm
authors.affiliation: Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Rådegran
authors.affiliation: Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016280:Atrial Function, Right; D062185:Atrial Pressure; D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: echocardiography; inferior vena cava; pulmonary hypertension; right atrial pressure; right atrial volume; three-dimensional