Objective: Determining right atrial pressure (RAP) is an important hemodynamic parameter for calculating right ventricular pressure, commonly measured using right heart catheterization, an invasive procedure. However, non-invasive methods should be prioritized, particularly in pediatric patients. There is a lack of evidence regarding this issue in pediatric and young adult populations compared to adults.
Method: This diagnostic cross-sectional study was conducted to investigate echocardiographic criteria for estimating right atrial pressure in 350 pediatric patients from March 2020 to December 2021.
Results: The mean right atrial pressure was significantly higher in patients with a Caval index of less than 50% (7.89 +- 4.48 mmHg vs. 6.3 +- 3.18 mmHg, P = 0.002) and in those with cyanotic congenital heart disease (CHD) (P = 0.018). There was a significant correlation between a Caval index cut-off point of 50% and a mean RAP cut-off point of 10 mmHg (P = 0.024), with a specificity of 85.7% for a Caval index < 50% in estimating right atrial pressure > 10 mmHg. Additionally, a difference was observed between the tricuspid valve E/E´ ratio with a cut-off point of 7 and the mean right atrial pressure with a cut-off point of 5 mmHg (P = 0.043), with a sensitivity of 70.2% for a tricuspid valve E/E´ratio > 7 in estimating right atrial pressure > 5 mmHg.
Conclusion: This study demonstrated that echocardiographic indices, such as the Caval index and tricuspid valve E/E´ ratio, can be useful in non-invasive estimation of right atrial pressure. However, age-specific reference values and cut-off points for these indices should be considered to improve their accuracy.