In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Estimation of pulmonary artery pressure from right atrial strain and tricuspid regurgitation velocity

Session Poster Session 5

Speaker Associate Professor Katsuji Inoue

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Tissue Doppler, Speckle Tracking and Strain Imaging
  • Session type : Poster Session

Authors : K Inoue (Oslo,NO), EW Remme (Oslo,NO), FH Khan (Oslo,NO), OS Andersen (Oslo,NO), E Gude (Oslo,NO), H Skulstad (Oslo,NO), OA Smiseth (Oslo,NO)

K Inoue1 , EW Remme1 , FH Khan1 , OS Andersen1 , E Gude1 , H Skulstad1 , OA Smiseth1 , 1Oslo University Hospital, Rikshospitalet - Oslo - Norway ,


Background: Systolic pulmonary artery pressure (SPAP) can be estimated non-invasively as the sum of indices for right atrial (RA) pressure and tricuspid regurgitation (TR) pressure gradient. Although echocardiographic evaluation of inferior vena cava diameter and collapsibility is currently being used to estimate RA pressure (IVC method), RA strain may be an alternative since atrial strain is related to atrial pressure.
Objective: We tested if RA strain by speckle tracking echocardiography can be used as a surrogate of mean RA pressure (RA strain method), and by adding the TR pressure gradient, be used to estimate SPAP.
Methods: We retrospectively analyzed 91 patients (mean age, 58 years) referred to right heart catheterization due to unexplained dyspnea or suspected pulmonary hypertension. Echocardiography was performed within 24 hours of the invasive procedure. RA reservoir strain was calculated from apical four-chamber view. SPAP was calculated as the sum of peak TR pressure gradient and estimated RA pressure by the IVC or RA strain methods. 
Results: Right heart catheterization showed SPAP and mean RA pressures of 51 ± 20 mmHg and 9 ± 6 mmHg, respectively. RA reservoir strain was inversely correlated with mean RA pressure (r= -0.61, p< 0.01). Thus, we set mean RA pressure as 5, 10 and 15 mmHg depending on high (=25%), middle (10-25%) and low (=10%) values of RA reservoir strain. As shown in the figure, both the RA strain and IVC methods when combined with peak TR velocity, provided good estimates of invasively measured SPAP. 
Conclusions: RA strain provides a semiquantitative measure of RA pressure, which can be used in combination with peak TR velocity to estimate SPAP. This approach can be used as an alternative when the IVC method is not available in cases with poor subcostal window.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are