Accuracy of Tissue Doppler Estimation of the Right Atrial Pressure in Anesthetized, Paralyzed, and Mechanically Ventilated Patients

doi:10.1016/j.amjcard.2005.12.061

The American Journal of Cardiology

Volume 97, Issue 11, 1 June 2006, Pages 1654-1656

https://doi.org/10.1016/j.amjcard.2005.12.061 Get rights and content

The ratio of tricuspid peak early inflow velocity to peak early diastolic velocity of the lateral tricuspid annulus (the E/Ea ratio) measured by transthoracic echocardiography has been reported to correlate with right atrial (RA) pressure. In this study, the correlation between the E/Ea ratio and RA pressure was tested in 44 anesthetized, paralyzed, and mechanically ventilated patients by transesophageal echocardiography. Mean RA pressure and the following echocardiographic data were recorded simultaneously: tricuspid peak early inflow velocities by Doppler echocardiography, peak early diastolic velocity of the lateral tricuspid annulus by tissue Doppler imaging, and right ventricular and left ventricular end-diastolic areas. Linear regression did not indicate a correlation between the E/Ea ratio and RA pressure (r = −0.11, p = 0.48) or between the E/Ea ratio and the right or left ventricular end-diastolic area index; it revealed a weak correlation between RA pressure and the inspiratory plateau pressure and body mass index. In conclusion, the E/Ea ratio failed to predict RA pressure or planimetric indexes of ventricular preload in anesthetized, paralyzed, and mechanically ventilated patients. In these patients, RA pressure was largely influenced by extracardiac factors.

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Acknowledgment

We thank Joan Etlinger, BA, for editorial assistance.

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Citation Excerpt :
As for the RV rIVRT method, the authors suggested the use of this method in patients without subcostal windows or in mechanically ventilated patients in which the IVC index is inaccurate. However, a recent study by Michaux et al64 demonstrated that Etr/E′tr failed to predict RAP in anesthetized, paralyzed, and mechanically ventilated patients. A good tricuspid regurgitation jet is fundamental for the estimation of sPAP and in some methods of dPAP estimation.
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Patients with moderate BPD had a higher early Doppler inflow velocity to the early tissue Doppler velocity ratio (E/E′ ratio; P = .03), corresponding to increased end diastolic pressure, compared with patients with no/mild BPD. Patients with severe BPD had a higher E/E′ ratio (P = .004) than patients with no/mild BPD. Linear regression demonstrated a correlation between BPD category and right ventricle E/E′ (P = .007, R² = 0.33) and left ventricular myocardial performance index (P = .02, R² = 0.28).
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: This study was supported in part by the Swiss Society of Anesthesiology and Resuscitation, Bern, Switzerland.

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Congenital heart diseaseAccuracy of Tissue Doppler Estimation of the Right Atrial Pressure in Anesthetized, Paralyzed, and Mechanically Ventilated Patients

Section snippets

Acknowledgment

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressuresa comparative simultaneous Doppler-catheterization study

Circulation

Congenital heart disease
Accuracy of Tissue Doppler Estimation of the Right Atrial Pressure in Anesthetized, Paralyzed, and Mechanically Ventilated Patients