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

OBJECTIVE
Determining the right atrial pressure is an important hemodynamic criterion for calculating right ventricular pressure, commonly measured using right heart catheterization (an invasive procedure). However, non-invasive methods should be prioritized, especially in pediatrics. There is a lack of evidence regarding this issue in such age groups compared to adults.


METHODS
The research was a diagnostic-type cross-sectional study conducted to investigate echocardiographic criteria for estimating the 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 CHD (P = 0.018). There was a significant correlation between the Caval index with a cut-off point of 50% and the mean RAP with a cut-off point of 10 mmHg (P-value = 0.024) with a specificity=85.7% of Caval index<50% for estimating right atrial pressure >10 mmHg. Additionally, there was a difference between the E/E´ of the tricuspid valve with a cut-off point of 7, and the mean right atrial pressure with a cut-off point of 5 mmHg (P-value =0.043), with a sensitivity=70.2% of tricuspid valve E/E´>7 for estimating right atrial pressure >5 mmHg.


CONCLUSION
This study showed that echocardiographic indices, such as the Caval index and tricuspid valve E/E´, can be useful in estimating right atrial pressure non-invasively. However, it is crucial to consider age-specific reference values and cut-off points for these indices to enhance their accuracy.