![]() Included patients with heart transplantation, and increased stiffness of the IVC at the join between the donor and recipient might have affected the IVC values or their respiratory variation. Although catheterization was performed within 24 h of IVC ultrasound, interpretation of the IVC parameters for RAP was limited. However, the major limitation of that study was that ultrasound and invasive measurement were not performed simultaneously. Recently, we reported that the cut-off values of IVC parameters to predict elevated RAP might be less than 21 mm and 50% in an Asian population. Although the current guidelines suggest a maximal IVCD >21 mm in conjunction with an IVC collapse <50% as cut-off thresholds for predicting RAP ≥10 mmHg, it is unclear whether these cut-off values in the current guidelines can be applied directly to Asian subjects. Moreover, most of the previous studies that support the current guidelines are derived from US and European populations. The numbers of subjects in those studies were merely 35, 9 There is no report that has compared invasive RAP with simultaneously obtained IVC parameters in a large cohort, and only a few small studies 9 – 11 As a matter of fact, despite the widespread use of the IVC approach for RAP assessment, there are no previous studies that have evaluated this technique in comparison with simultaneous invasive methods. However, in the clinical setting, sometimes the invasive RAP and RAP estimated from IVC parameters are not concordant. 2Ĭurrently, estimation of RAP using ultrasound measurements of the inferior vena cava (IVC) diameter (IVCD), together with its respiratory variation, is commonly performed, because it is simple and noninvasive and recommended in the current guidelines of the American Society of Echocardiography in conjunction with the European Association of Echocardiography. Noninvasive assessment of RAP is used to estimate systolic pulmonary artery pressure in conjunction with the tricuspid regurgitation pressure gradient, and this assessment also plays a critical role in the management of volume control in patients with congestive heart failure. Indexed IVCDmax may be an IVC parameter that can be used internationally.Īn elevated right atrial pressure (RAP) is a major prognostic predictor of morbidity and mortality in patients with pulmonary hypertension. The optimal absolute IVCDmax and IVCCI cut-offs to detect elevated RAP were smaller than those in the current guidelines. When we combined both cut-off values (11 mm/m 2Īnd 40%), the sensitivity and specificity were 75% and 95%, respectively. Interestingly, the cut-off value of the optimal IVCDmax indexed by body surface area (11 mm/m 2) was similar to previous Western population data. When the cut-off values from the current guidelines (>21 mm and <50%) were applied, the respective sensitivity and specificity were 42% and 99%. When we combined both in proportion to the guidelines, the sensitivity and specificity for detecting elevated RAP were 75% and 94%, respectively. The optimal maximum IVCD (IVCDmax) and IVCCI cut-offs for detecting elevated RAP (RAP ≥10 mmHg) were 17 mm and 40%, respectively. The IVCD and IVC collapsibility index (IVCCI) were measured according to the current guidelines. We prospectively enrolled 120 East Asian patients who were scheduled for catheterization. We explored the best cut-off values of IVC parameters for elevated RAP in comparison with RAP measured by catheterization. However, there is a paucity of studies that have compared this technique with simultaneous catheterization. Ultrasound measurements of the inferior vena cava (IVC) diameter (IVCD), together with its respiratory variation, provide a noninvasive estimate of right atrial pressure (RAP). Department of Cardiovascular Medicine, the University of Tokyoĭepartment of Clinical Laboratory, the University of Tokyoĭivision of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical Universityĭepartment of Cardiology, Sakakibara Heart Instituteĭepartment of Cardiovascular Surgery, Juntendo University School of Medicine
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