Key result
Echocardiographic RV-E/e′ demonstrated good accuracy but poor precision for estimating right atrial pressure, suggesting it may be useful for population-level studies rather than individual clinical decision making.
Why the study?
Right atrial pressure is diagnostically and prognostically significant, but current two-dimensional echocardiographic methods are inadequate for its accurate estimation.
Does echocardiographic RV-E/e' accurately estimate invasively measured right atrial pressure?
Systematic Review
Does echocardiographic RV-E/e' accurately estimate invasively measured right atrial pressure?
Echocardiographic RV-E/e' may be useful for estimating right atrial pressure at a population level but lacks the precision required for individual clinical decision making.
RV-E/e' lacks precision for individual right atrial pressure decisions; limits clinical adoption while supporting targeted research in CAD and RV dysfunction.
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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Fletcher et al. (2020) conducted a systematic review in Various cardiac and pulmonary diseases requiring right heart catheterization. Echocardiographic RV-E/e′ vs. Invasive right heart catheterization was evaluated on Diagnostic accuracy and correlation of RV-E/e′ for predicting right atrial pressure. Echocardiographic RV-E/e′ demonstrated good accuracy but poor precision for estimating right atrial pressure, suggesting it may be useful for population-level studies rather than individual clinical decision making.
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