Estimation of Right Atrial Pressure by E/Ea Ratio of Tricuspid Valve
Abstract
Background. Right atrial pressure is one of hemodynamic parameter that can guide therapy for patients in intensive care unit. Right atrial pressure is also needed for calculation of other hemodynamic parameter such as pulmonary pressure and systemic vascular resistance. Estimation of right atrial pressure using E/Ea ratio is not much studied until now. There were only three studies with different result. This study objective is therefore to asses the correlation and agreement of estimation right atrial pressure by using ratio E wave (spectral doppler) and Ea wave (tissue doppler imaging) from tricuspid valve.Methods.This is a diagnostic test with cross sectional design study in patients in Cardiovascular Care Unit (CVCU) who had been inserted central venous pressure line (CVP line). E wave was taken from tricuspid inflow with pulsed wave spectral doppler and Ea wave was taken from the lateral tricuspid annulus with tissue doppler imagingat at early diastolic filling. Correlation analysis was performed to assess the correlation of E/Ea ratio with right atrial pressure from CVP line. The result of E/Ea ratio liner regrresion is analyzed with bland altman plot to asses agreement between E/Ea ratio and invasive methods of CVP line. Data was analyzed using SPSS 15.0.
Results.There were 50 from 16 sample. As many as 20 data was also also measured by second observer for interobserver variability. There was a good precision for inter and intraobserver with ICC > 0,8. There was good correlation between E/Ea ratio with right atrial pressure, r = 0.728, p < 0,001. Cut off point E/Ea >3,95 could predict right atrial pressure = 10 mmHg (sensitvity 73,1% and specificity 70,8% and positive predictive value 73% and negative predictive value 73,9%). The agreement between E/Ea ratio and CVP line for measuring right atrial prssure was poor, with Intra-class Correlation(ICC) 24% and percentage error more than 30%. Based on this agreement right atrial pressure estimated by E/Ea ratio could have difference as much as 0,01 +3,53 mmHg.
Conclusion.There were good correlation but poor agreeement for right atrial pressure estimation by using E/Ea ratio.
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References
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Beaulieu Y, Marik PE. Bedside Ultrasonography in the ICU. Chest. 2005;128: 881-95.
Non-invasive quantitation of cardiac hemodynamics with Echocardiography and Doppler ultrasound. Archivos de Cardiologia de Mexico. 2004; 74 (Supl. 2): S230-3.
Oren-Grinberg A, Lerner AB, Talmor D. Echocardiography in the Intensive Care Unit. In: Irwin RS, Rippe JM, Lisbon A, Heard SO, eds. Procedures, Techniques, and Minimally Invasive Monitoring in Intensive Care Medicine. USA: Lippincott Williams & Wilkins. 2008: 324.
Kwan S, Abbas A, Khanderia B. Echocardiographic Assessment of Right Heart Hemodynamic Parameters. Journal of the American Society of Echocardiography. 2007; 20: 773-82.
Brennan JM, Blair J, Gooneawrdena S, Ronan A, Shah D, Kirkpatrick J, dkk. Reappraisal of the Use of Inferior Vena Cava for Estimating Right Atrial Pressure. Am Soc Echocardiogr. 2007; 20: 857 – 61.
Jue J, Schiller CW. Does Inferior Vena Cava Size Predict Right Atrial Pressures in Patients Receiving Maechanical Ventilator? J Am Soc Echocardiogr. 1992; 5: 613 – 9.
Nagueh MF, Kopelen HA, Zoghbi W. Estimation of mean Right Atrial Pressure Using Tissue Doppler Imaging. Am J Cardiol. 1999; 84: 1448 -50.
Sade L, Gulmez O, Sezgin A. Non invasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr. 2007; 20: 982-8.
Michaux I, Miodrag Filipovic, Skarvan K. Accuracy of Tissue Doppler Estimation of the Right Atrial Pressure in Anesthesized, Paralyzed, and Mechanically Ventilated Patients. Am J Cardiol. 2006; 97: 1654–6.
Feigenbaum H. the Echocardiogrphic Exmination. In: Feigenbaum H, Amstrong W, Ryan T. Feigenbaum’s Echocardiography. 6thed. USA: Lipincot Williams & Wilkins. 2005 : 112-6.
Oh JK. Transthoracic Examination. In : Echo Manual. 3rd ed. Oh JK, Seward JB, Tajik AJ eds. USA: Lippincott WIlliams & Wilkins. 2006: 8 - 15.
Zoghbi W, Habib G, Quinones M. Doppler Assesment of Right Ventricular Fillin in a normal population comparison with Left ventricular filiing Dynamics. Circulation. 1990; 82; 1316-24.
Madger S. Invasive Intravascular Hemodynamic Monitoring: Technical Issues. Crit Care Clin. 2007;23: 401–41.
Madger S. How to use central venous pressure measurements. Curr Opin Crit Care. 2005;11: 264-70.
Brazdzionyte J, Macas A. Bland Altman analysis as an alternative approach for statistical evaluation of agreement between two methods for measuring hemodynamics during acute myocardial infarction. Medicina (Kaunas) 2007; 43: 208-14.
Bland JM, Altman DG. Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol. 2003; 22: 85–93.
Oh JK. Diastolic Dysfunction. In : Echo Manual. 3rd ed. Oh JK, Seward JB, Tajik AJ eds. USA: Lippincott WIlliams & Wilkins. 2006: 124 – 5.
Feigenbaum H. Evaluation of systolic and diastolic LV function. In: Feigenbaum H, Amstrong W, Ryan T. Feigenbaum’s Echocardiography. 6th ed. USA: Lipincot Williams & Wilkins. 2005:169 - 74.
Hannoush H, Fawzy ME, Stefadouros M, Moursi M, Chaudhary MA, Dunn B. Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis. Am Heart J. 2004; 148: 865-70.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Surgeons With the American Association for Thoracic Surgery and Society of Thoracic Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2008; 51: 1-62.
Barbeito A, Mark JB. Arterial and Central Venous Pressure Monitoring. Anesthesiology Clin. 2006; 24: 717-35.
Horton KD, Hill JC. Assessment of the Right Ventricle by Echocardiography: A Primer for Cardiac Sonographers. J Am Soc Echocardiogr. 2009; 22: 777-9.
Adams B, Lyon ML, DeFlorio P. Central Venous Catheterization and Central Venous Pressure Monitoring. In : Roberts JR, Hedges JR. Roberts: Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia: Elsevier; 2009. www.MDconsult.com
Guron CW, Bech-Hanssen O, Wikh R, Rosengren A, Hartford M, Caidahl K. The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment. Eur J Echocardiography. 2005; 6: 419-28.
Wang B. Effect of posture and positive end expiratory pressure on central venous pressure in patients with mechanical ventilation. Chinese critical care Med.2007; 19: 104-6.
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How to Cite
Hanifah, Y., Soesanto, A., Sunu, I., & Harimurti, G. (1). Estimation of Right Atrial Pressure by E/Ea Ratio of Tricuspid Valve. Indonesian Journal of Cardiology, 31(1), 3-13. https://doi.org/10.30701/ijc.v31i1.151
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Clinical Research
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