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Abstract <p>Disproportionate right and left ventricular filling pressures, as measured using right atrial to wedge pressure (RA/WP) is a marker of right heart failure and worse outcomes in patients with heart failure (HF), but an invasive hemodynamic study is needed to measure RA/WP. Using echocardiography, an estimation of RA/WP (eRA/WP) could be calculated non-invasively. The aim of the present study was to understand the feasibility and usefulness of eRA/WP in the general HF population where invasive assessment is not routinely done.&#xa0;Estimated RA/WP was calculated using mitral E velocity, lateral and septal tissue Doppler velocities and inferior vena cava diameter. A second dataset obtained from patients undergoing cardiac catheterization was used to determine agreement between eRA/WP and catheter-derived RA/WP.&#xa0;Estimated RA/WP showed significant correlations with right atrial area (<i>r</i> = 0.27,<i>p</i> &lt; 0.001), right ventricular diameter (<i>r</i> = 0.20,<i>p</i> = 0.006), right ventricular fractional area change (<i>r</i>=-0.19,<i>p</i> = 0.01) and systolic pulmonary artery pressure (<i>r</i> = 0.44,<i>p</i> &lt; 0.001). Being in the highest quartile was significantly associated with the primary composite endpoint at 180 days in unadjusted (OR:2.28,95%CI:1.20–4.36,<i>p</i> = 0.012) and adjusted (OR:2.59,95%CI:1.26–5.31, <i>p</i> = 0.009) models. Intraclass correlation coefficients for agreement between eRA/WP and catheter-based RA/WP was 0.72 for single measures and 0.84 for average measures.&#xa0;Assessment of disproportionate right to left ventricular filling pressures using echocardiographic estimation of RA/WP is feasible and useful to predict short-term prognosis in HF patients.</p> Graphical abstract <p>Study rationale, design and workflow.The aim of the present work was to understand whether the proportionality of the right to left ventricular filling pressures could be estimated non invasively using an echocardiographic method. Findings demonstrated that estimated right atrial to wedge pressure ratio was correlated with right ventricular dimensions and functional parameters, and was useful to predict heart failure hospitalizations and mortality at 6 months. Thus, an echocardiographic estimation of right atrial to wedge pressure ratio appears as a simple and feasible parameter that could be used to assess disproportionate right to left ventricular filling pressures in those not undergoing invasive assessment.</p> <p></p>

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Noninvasive assessment of disproportionate right to left ventricular filling pressure in patients with heart failure

  • 期刊论文

  • 发表日期：

    2025年11月21日

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  • Tolga Sinan Güvenç,
  • Lale Dinç Asarcıklı,
  • Duygu İnan,
  • Selda Murat,
  • İnci Tuğçe Çöllüoğlu,
  • Nijat Bakhshaliyev,
  • Zeynep Ulutaş,
  • Gizem Çabuk,
  • Senem Hasırcı,
  • Yalçın Velibey,
  • Şennur Ünal Dayı,
  • Ahmet Çelik

摘要

Abstract

Disproportionate right and left ventricular filling pressures, as measured using right atrial to wedge pressure (RA/WP) is a marker of right heart failure and worse outcomes in patients with heart failure (HF), but an invasive hemodynamic study is needed to measure RA/WP. Using echocardiography, an estimation of RA/WP (eRA/WP) could be calculated non-invasively. The aim of the present study was to understand the feasibility and usefulness of eRA/WP in the general HF population where invasive assessment is not routinely done. Estimated RA/WP was calculated using mitral E velocity, lateral and septal tissue Doppler velocities and inferior vena cava diameter. A second dataset obtained from patients undergoing cardiac catheterization was used to determine agreement between eRA/WP and catheter-derived RA/WP. Estimated RA/WP showed significant correlations with right atrial area (r = 0.27,p < 0.001), right ventricular diameter (r = 0.20,p = 0.006), right ventricular fractional area change (r=-0.19,p = 0.01) and systolic pulmonary artery pressure (r = 0.44,p < 0.001). Being in the highest quartile was significantly associated with the primary composite endpoint at 180 days in unadjusted (OR:2.28,95%CI:1.20–4.36,p = 0.012) and adjusted (OR:2.59,95%CI:1.26–5.31, p = 0.009) models. Intraclass correlation coefficients for agreement between eRA/WP and catheter-based RA/WP was 0.72 for single measures and 0.84 for average measures. Assessment of disproportionate right to left ventricular filling pressures using echocardiographic estimation of RA/WP is feasible and useful to predict short-term prognosis in HF patients.

Graphical abstract

Study rationale, design and workflow.The aim of the present work was to understand whether the proportionality of the right to left ventricular filling pressures could be estimated non invasively using an echocardiographic method. Findings demonstrated that estimated right atrial to wedge pressure ratio was correlated with right ventricular dimensions and functional parameters, and was useful to predict heart failure hospitalizations and mortality at 6 months. Thus, an echocardiographic estimation of right atrial to wedge pressure ratio appears as a simple and feasible parameter that could be used to assess disproportionate right to left ventricular filling pressures in those not undergoing invasive assessment.