Detection of elevated right atrial pressure using a simple bedside ultrasound measure

作者：Simon Marc A; Kliner Dustin E; Girod John P; Moguillansky Diego; Villanueva Flordeliza S; Pacella John J^*

来源：American Heart Journal, 2010, 159(3): 421-427.

DOI：10.1016/j.ahj.2010.01.004

Aims Accurate assessment of right atrial pressure (RAP) often requires invasive measurement. With normal RAP, Valsalva increases right internal jugular vein (RUV) cross sectional area (CSA) 20% to 30%. With high RAP, when venous compliance is low, we hypothesized that the increase in CSA would be blunted and could be detected non-invasively with bedside ultrasound.
Methods and Results RUV ultrasound images were obtained in 67 patients undergoing right heart catheterization. The median RAP at end-expiration was 7 mm Hg (interquartile range [IQR] 5-9 mm Hg) in patients with normal RAP (n = 47) versus 15 mm Hg (IQR 12-22 mm Hg) in patients with elevated RAP (n = 20). With Valsalva, the median percent change in RUV CSA was 35% (IQR 19%-79%) versus 5% (IQR 3%-14%) for normal and high RAP, respectively. By receiver operating curve analysis, a < 17% increase in RUV CSA with Valsalva predicted elevated RAP (>= 12 mmHg) with 90% sensitivity, 74% specificity, 94% negative predictive value, and 60% positive predictive value (area under the curve 0.86, P < .001).
Conclusions An increase in RUV CSA > 17% during Valsalva effectively rules out elevated RAP. This simple bedside technique may be useful to assess central venous pressure and reduce the need for invasive pressure measurement. (Am Heart J 2010; 159: 421-7.)

• 出版日期2010-3