The prognostic value of the relationship between right atrial and pulmonary capillary wedge pressure in diverse cardiovascular conditions

Douglas Marshall Brinkley, Kalon K.L. Ho, Mark H. Drazner, Robb D. Kociol

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Physical examination of jugular venous pressure is used to estimate right atrial (RA) pressure and infer left-sided filling pressure to assist volume management. Previous studies in advanced heart failure patients showed about 75% concordance between RA and pulmonary capillary wedge (PCW) pressures. We sought to determine the relationship between mean RA and mean PCW pressure and assess the clinical significance in a broad population of patients undergoing invasive right heart catheterization (RHC). Methods: We examined 4135 RHC cases at a single academic medical center from February 2007 to December 2014, analyzing baseline variables, hemodynamic data, and in-hospital mortality. Results: The overall Pearson correlation for mean RA and PCW pressures was 0.68 with 70% concordance between dichotomized pressures (RA ≥10 and PCW ≥22 mmHg). Results were similar in subgroups with heart failure (r = 0.67, 72%), STEMI/NSTEMI (r = 0.60, 69%), unstable angina (r = 0.78, 69%), stable/no angina (r = 0.72, 67%), and valvular disease (r = 0.61, 72%; Chi-square P =.15). Mean RA pressure was independently associated with in-hospital mortality in multivariate analysis (OR 1.12 [95% CI 1.081-1.157] per 1 mmHg increase, P <.001). The RA/PCW ratio was not independently associated with in-hospital mortality. Mean RA pressure was also weakly associated with worse renal function (rho = −0.16, P <.001). Conclusion: In patients undergoing right catheterization for diverse indications, the mean RA and PCW pressures correlated moderately well, but there was discordance in a sizable minority, in whom assessment of left-sided filling pressures using estimated jugular venous pressure may be misleading. Elevated right atrial pressure is a marker for in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)31-36
Number of pages6
JournalAmerican Heart Journal
Volume199
DOIs
StatePublished - May 1 2018

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Pulmonary Wedge Pressure
Atrial Pressure
Hospital Mortality
Venous Pressure
Cardiac Catheterization
Neck
Heart Failure
Pressure
Lung
Stable Angina
Unstable Angina
Patient Rights
Catheterization
Physical Examination
Multivariate Analysis
Hemodynamics
Kidney
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The prognostic value of the relationship between right atrial and pulmonary capillary wedge pressure in diverse cardiovascular conditions. / Brinkley, Douglas Marshall; Ho, Kalon K.L.; Drazner, Mark H.; Kociol, Robb D.

In: American Heart Journal, Vol. 199, 01.05.2018, p. 31-36.

Research output: Contribution to journalArticle

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abstract = "Background: Physical examination of jugular venous pressure is used to estimate right atrial (RA) pressure and infer left-sided filling pressure to assist volume management. Previous studies in advanced heart failure patients showed about 75{\%} concordance between RA and pulmonary capillary wedge (PCW) pressures. We sought to determine the relationship between mean RA and mean PCW pressure and assess the clinical significance in a broad population of patients undergoing invasive right heart catheterization (RHC). Methods: We examined 4135 RHC cases at a single academic medical center from February 2007 to December 2014, analyzing baseline variables, hemodynamic data, and in-hospital mortality. Results: The overall Pearson correlation for mean RA and PCW pressures was 0.68 with 70{\%} concordance between dichotomized pressures (RA ≥10 and PCW ≥22 mmHg). Results were similar in subgroups with heart failure (r = 0.67, 72{\%}), STEMI/NSTEMI (r = 0.60, 69{\%}), unstable angina (r = 0.78, 69{\%}), stable/no angina (r = 0.72, 67{\%}), and valvular disease (r = 0.61, 72{\%}; Chi-square P =.15). Mean RA pressure was independently associated with in-hospital mortality in multivariate analysis (OR 1.12 [95{\%} CI 1.081-1.157] per 1 mmHg increase, P <.001). The RA/PCW ratio was not independently associated with in-hospital mortality. Mean RA pressure was also weakly associated with worse renal function (rho = −0.16, P <.001). Conclusion: In patients undergoing right catheterization for diverse indications, the mean RA and PCW pressures correlated moderately well, but there was discordance in a sizable minority, in whom assessment of left-sided filling pressures using estimated jugular venous pressure may be misleading. Elevated right atrial pressure is a marker for in-hospital mortality.",
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N2 - Background: Physical examination of jugular venous pressure is used to estimate right atrial (RA) pressure and infer left-sided filling pressure to assist volume management. Previous studies in advanced heart failure patients showed about 75% concordance between RA and pulmonary capillary wedge (PCW) pressures. We sought to determine the relationship between mean RA and mean PCW pressure and assess the clinical significance in a broad population of patients undergoing invasive right heart catheterization (RHC). Methods: We examined 4135 RHC cases at a single academic medical center from February 2007 to December 2014, analyzing baseline variables, hemodynamic data, and in-hospital mortality. Results: The overall Pearson correlation for mean RA and PCW pressures was 0.68 with 70% concordance between dichotomized pressures (RA ≥10 and PCW ≥22 mmHg). Results were similar in subgroups with heart failure (r = 0.67, 72%), STEMI/NSTEMI (r = 0.60, 69%), unstable angina (r = 0.78, 69%), stable/no angina (r = 0.72, 67%), and valvular disease (r = 0.61, 72%; Chi-square P =.15). Mean RA pressure was independently associated with in-hospital mortality in multivariate analysis (OR 1.12 [95% CI 1.081-1.157] per 1 mmHg increase, P <.001). The RA/PCW ratio was not independently associated with in-hospital mortality. Mean RA pressure was also weakly associated with worse renal function (rho = −0.16, P <.001). Conclusion: In patients undergoing right catheterization for diverse indications, the mean RA and PCW pressures correlated moderately well, but there was discordance in a sizable minority, in whom assessment of left-sided filling pressures using estimated jugular venous pressure may be misleading. Elevated right atrial pressure is a marker for in-hospital mortality.

AB - Background: Physical examination of jugular venous pressure is used to estimate right atrial (RA) pressure and infer left-sided filling pressure to assist volume management. Previous studies in advanced heart failure patients showed about 75% concordance between RA and pulmonary capillary wedge (PCW) pressures. We sought to determine the relationship between mean RA and mean PCW pressure and assess the clinical significance in a broad population of patients undergoing invasive right heart catheterization (RHC). Methods: We examined 4135 RHC cases at a single academic medical center from February 2007 to December 2014, analyzing baseline variables, hemodynamic data, and in-hospital mortality. Results: The overall Pearson correlation for mean RA and PCW pressures was 0.68 with 70% concordance between dichotomized pressures (RA ≥10 and PCW ≥22 mmHg). Results were similar in subgroups with heart failure (r = 0.67, 72%), STEMI/NSTEMI (r = 0.60, 69%), unstable angina (r = 0.78, 69%), stable/no angina (r = 0.72, 67%), and valvular disease (r = 0.61, 72%; Chi-square P =.15). Mean RA pressure was independently associated with in-hospital mortality in multivariate analysis (OR 1.12 [95% CI 1.081-1.157] per 1 mmHg increase, P <.001). The RA/PCW ratio was not independently associated with in-hospital mortality. Mean RA pressure was also weakly associated with worse renal function (rho = −0.16, P <.001). Conclusion: In patients undergoing right catheterization for diverse indications, the mean RA and PCW pressures correlated moderately well, but there was discordance in a sizable minority, in whom assessment of left-sided filling pressures using estimated jugular venous pressure may be misleading. Elevated right atrial pressure is a marker for in-hospital mortality.

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