Diagnostic Value of Echocardiographic Indices in Determining Right Atrial Pressure Compared to Catheterization in Pediatrics and Young Adults

OBJECTIVE
Determining right atrial pressure (RAP) is an important hemodynamic parameter for calculating right ventricular pressure, commonly measured using right heart catheterization, an invasive procedure. However, non-invasive methods should be prioritized, particularly in pediatric patients. There is a lack of evidence regarding this issue in pediatric and young adult populations compared to adults.


METHOD
This diagnostic cross-sectional study was conducted to investigate echocardiographic criteria for estimating right atrial pressure in 350 pediatric patients from March 2020 to December 2021.


RESULTS
The mean right atrial pressure was significantly higher in patients with a Caval index of less than 50% (7.89 ± 4.48 mmHg vs. 6.3 ± 3.18 mmHg, P = 0.002) and in those with cyanotic congenital heart disease (CHD) (P = 0.018). There was a significant correlation between a Caval index cut-off point of 50% and a mean RAP cut-off point of 10 mmHg (P = 0.024), with a specificity of 85.7% for a Caval index < 50% in estimating right atrial pressure > 10 mmHg. Additionally, a difference was observed between the tricuspid valve E/E´ ratio with a cut-off point of 7 and the mean right atrial pressure with a cut-off point of 5 mmHg (P = 0.043), with a sensitivity of 70.2% for a tricuspid valve E/E´ratio > 7 in estimating right atrial pressure > 5 mmHg.


CONCLUSION
This study demonstrated that echocardiographic indices, such as the Caval index and tricuspid valve E/E´ ratio, can be useful in non-invasive estimation of right atrial pressure. However, age-specific reference values and cut-off points for these indices should be considered to improve their accuracy.