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Original Research: Pulmonary Vascular Disease |

Echocardiographic Assessment of Estimated Right Atrial Pressure and Size Predicts Mortality in Pulmonary Arterial HypertensionEstimated Right Atrial Pressure Predicts Mortality

Christopher Austin, MD; Khadija Alassas, MD; Charles Burger, MD, FCCP; Robert Safford, MD, PhD; Ricardo Pagan, MD; Katherine Duello, MD; Preetham Kumar, MD; Tonya Zeiger, RRT; Brian Shapiro, MD
Author and Funding Information

From the Division of Cardiovascular Disease (Drs Austin, Alassas, Safford, Duello, Kumar, and Shapiro), Division of Pulmonary Disease (Dr Burger and Ms Zeiger), and Division of Internal Medicine (Dr Pagan), Mayo Clinic, Mayo Foundation for Medical Education and Research, Jacksonville, FL.

CORRESPONDENCE TO: Brian Shapiro, MD, Department of Cardiovascular Disease, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; e-mail: shapiro.brian@mayo.edu


FUNDING/SUPPORT: This work was supported by Center for Translational Science activities [Grant UL1 TR000135].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):198-208. doi:10.1378/chest.13-3035
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BACKGROUND:  Elevated mean right atrial pressure (RAP) measured by cardiac catheterization is an independent risk factor for mortality. Prior studies have demonstrated a modest correlation with invasive and noninvasive echocardiographic RAP, but the prognostic impact of estimated right atrial pressure (eRAP) has not been previously evaluated in patients with pulmonary arterial hypertension (PAH).

METHODS:  A retrospective analysis of 121 consecutive patients with PAH based on right-sided heart catheterization and echocardiography was performed. The eRAP was calculated by inferior vena cava diameter and collapse using 2005 and 2010 American Society of Echocardiography (ASE) definitions. Accuracy and correlation of eRAP to RAP was assessed. Kaplan-Meier survival analysis by eRAP, right atrial area, and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry) risk criteria as well as univariate and multivariate analysis of echocardiographic findings was performed.

RESULTS:  Elevation of eRAP was associated with decreased survival time compared with lower eRAP (P < .001, relative risk = 7.94 for eRAP > 15 mm Hg vs eRAP ≤ 5 mm Hg). Univariate analysis of echocardiographic parameters including eRAP > 15 mm Hg, right atrial area > 18 cm2, presence of pericardial effusion, right ventricular fractional area change < 35%, and at least moderate tricuspid regurgitation was predictive of poor survival. However, multivariate analysis revealed that eRAP > 15 mm Hg was the only echocardiographic risk factor that was predictive of mortality (hazard ratio = 2.28, P = .037).

CONCLUSIONS:  Elevation of eRAP by echocardiography at baseline assessment was strongly associated with increased risk of death or transplant in patients with PAH. This measurement may represent an important prognostic component in the comprehensive echocardiographic evaluation of PAH.

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