Background

There is a paucity of data on the utility of right atrial pressure (RAP) for estimating pulmonary capillary wedge pressure (PCWP) in patients with normal ejection fraction (EF), including patients with heart failure with preserved EF.

Methods

Mean RAP was compared with PCWP in 129 patients (mean age, 61 ± 11 years; 45% men) with exertional dyspnea enrolled in a multicenter study. Measurements included left ventricular volumes, EF, and mitral inflow velocities.

Results

Mean PCWP was 14 ± 7 mm Hg, and mean RAP was 8 ± 5 mm Hg. A significant relation was present between mean RAP and mean PCWP (r² = 0.5, P < .001). RAP > 8 mm Hg had 76% sensitivity and 86% specificity in detecting mean PCWP > 12 mm Hg. In 101 patients with inconclusive mitral filling pattern (defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 diastolic function recommendations), RAP by catheterization had sensitivity of 73% and specificity of 91%. In a subset of 59 patients with echocardiographic assessment of mean RAP, RAP by echocardiography had sensitivity of 76% and specificity of 89%.

Conclusions

Mean RAP provides useful information about mean PCWP in many patients with normal left ventricular EF. There is good sensitivity and excellent specificity when combining invasive or noninvasive RAP and mitral velocities to determine if PCWP is elevated.

中文翻译：

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估计左心室射血分数正常的左心室充盈压的平均右心房压力：有创和无创验证

背景

关于右心房压力（RAP）在估计射血分数（EF）正常的患者（包括患有EF保留的心力衰竭的患者）的肺毛细血管楔压（PCWP）中的实用性的数据很少。

方法

在一项多中心研究中，将129例劳力性呼吸困难的患者（平均年龄61±11岁；男性45％）的RAP与PCWP进行了比较。测量包括左心室容积，EF和二尖瓣流入速度。

结果

平均PCWP为14±7毫米汞柱，平均RAP为8±5毫米汞柱。平均RAP与平均PCWP之间存在显着关系（r ²  = 0.5，P  <.001）。RAP> 8 mm Hg在检测平均PCWP> 12 mm Hg时具有76％的灵敏度和86％的特异性。在101名二尖瓣充盈模式没有定论的患者中（根据美国超声心动图学会/欧洲心血管影像协会2016年舒张功能建议进行定义），经导管置管的RAP敏感性为73％，特异性为91％。在59例接受超声心动图平均RAP评估的患者中，超声心动图对RAP的敏感性为76％，特异性为89％。

结论

平均RAP提供了许多左室EF正常患者平均PCWP的有用信息。当结合有创或无创RAP和二尖瓣速度确定PCWP是否升高时，具有良好的敏感性和出色的特异性。