Implication of Right Atrial Pressure Estimated by Echocardiography in Patients with Severe Tricuspid Regurgitation

Taku Omori; Ken Kuwajima; Florian Rader; Robert J Siegel; Takahiro Shiota

doi:10.1016/j.echo.2023.06.009

Implication of Right Atrial Pressure Estimated by Echocardiography in Patients with Severe Tricuspid Regurgitation

J Am Soc Echocardiogr. 2023 Nov;36(11):1170-1177. doi: 10.1016/j.echo.2023.06.009. Epub 2023 Jun 24.

Authors

Taku Omori¹, Ken Kuwajima¹, Florian Rader², Robert J Siegel², Takahiro Shiota³

Affiliations

¹ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
² Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, University of California, Los Angeles, Los Angeles, California.
³ Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, University of California, Los Angeles, Los Angeles, California. Electronic address: shiotat@cshs.org.

PMID: 37356676
DOI: 10.1016/j.echo.2023.06.009

Abstract

Background: Little is known about how tightly right atrial pressure (RAP) is associated with prognosis in patients with severe tricuspid regurgitation (TR). The aim of this study was to investigate the association of RAP estimated by echocardiography (RAP-echo) with cardiovascular events in patients with severe TR.

Methods: Two hundred forty outpatients (median age, 75 years; 130 women) who underwent two-dimensional transthoracic echocardiography and were diagnosed with severe TR were retrospectively studied. According to RAP-echo using the diameter of the inferior vena cava and its response to a sniff, patients were classified into two groups: low or middle and high RAP-echo. Cardiovascular events were defined as cardiovascular death and admission for heart failure.

Results: During follow-up (median, 428 days; range, 87-1,229 days), 64 patients experienced cardiovascular events. By multivariate analysis, high RAP-echo was independently associated with cardiovascular events (hazard ratio, 2.46; 95% CI, 1.17-5.18). Also, jugular venous distention and leg edema were not independently associated with cardiovascular events.

Conclusions: The significant and stronger association of RAP-echo with clinical outcome compared with estimates of RAP on physical examination suggests that recognition of high RAP-echo can be a valuable surrogate for the clinical management of severe TR patients.

Keywords: Prognosis; Right atrial pressure; Severe tricuspid regurgitation; Transthoracic echocardiography.

MeSH terms

Aged
Atrial Pressure
Echocardiography / methods
Female
Heart Failure*
Humans
Retrospective Studies
Tricuspid Valve Insufficiency* / diagnostic imaging