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Echocardiographic RV-E/e′ for predicting right atrial pressure: a review

Echo Research & Practice volume 7, pages R11–R20 (2020)Cite this article

Abstract

Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e′ ratio–a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e′ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operating characteristic analyses showed reasonable diagnostic ability of RV-E/e′ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e′ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland–Altman analyses showed good accuracy but poor precision of RV-E/e′ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e′ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e′, nor about the independent prognostic ability of RV-E/e′. Recommended areas for future research concerning RV-E/e′ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this review.

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Authors and Affiliations

  1. Department of Cardiac Physiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK

    A. J. Fletcher MSc

  2. Department of Cardiac Investigations, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough, UK

    S. Robinson MSc

  3. Department of Cardiology, Imperial College London NHS Foundation Trust, London, UK

    B. S. Rana MBBS MRCP

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Correspondence to A. J. Fletcher MSc.

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Fletcher, A.J., Robinson, S. & Rana, B.S. Echocardiographic RV-E/e′ for predicting right atrial pressure: a review. Echo Res Pract 7, R11–R20 (2020). https://doi.org/10.1007/BF03651759

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