Portable handheld ultrasound beneficial for estimating right atrial pressure in clinic

Right atrial pressure estimated by a portable hand-held ultrasound corresponded with B-type natriuretic peptide and was an independent predictor of clinical worsening in patients with pulmonary hypertension, researchers reported.

“Portable handheld point-of-care ultrasound is a quick and easy method of estimating right atrial pressure, which makes it attractive to use in outpatient pulmonary hypertension clinics,” Sneha Samant, MD, pulmonary disease specialist at the Louisiana State University Health Sciences Center, New Orleans, and East Jefferson General Hospital, Metairie, Louisiana, and colleagues wrote in Annals of the American Thoracic Society.

Samant and colleagues conducted a prospective observational study that included 90 outpatients from the Pulmonary Hypertension Comprehensive Care Center clinic with same-day B-type natriuretic peptide (BNP) measurements. Researchers used handheld ultrasound with a phased array (General Electric Vscan) to measure inferior vena cava size and collapsibility and estimate right atrial pressure. Patients were categorized as having normal (n = 27), intermediate (n = 49) or high (n = 12) estimated right atrial pressure.

Researchers compared portable handheld ultrasound measurements with BNP at baseline and over time.

Patients with intermediate or high estimated right atrial pressure had higher BNP concentrations compared with patients with normal estimated right atrial pressure (166 pg/mL and 236 pg/mL vs. 70 pg/mL, respectively). For every estimated right atrial pressure category transition between clinic visits, researchers observed an average BNP change of 155 pg/mL.

Forty-nine patients experienced at least one pulmonary hypertension worsening event. Twelve patients died, 26 had pulmonary hypertension-related hospitalizations, nine experienced worsening functional class with the addition of disease-specific medication and two underwent lung transplantation.

The rate of 3-year event-free survival was 77% among those with normal estimated right atrial pressure compared with 36% for those with intermediate estimated right atrial pressure and 9% for those with high estimated right atrial pressure.

Higher baseline estimated right atrial pressure category at baseline was independently associated with a more than twofold increased risk for clinical worsening in pulmonary hypertension (HR = 2.44; 95% CI, 1.47-4.07).

“Portable ultrasound inferior vena cava measurements were quick and feasible, suggesting that they can be easily incorporated into pulmonary hypertension outpatient practice,” the researchers wrote. “If replicated by other centers, these findings could support the use of in-clinic estimation of right atrial pressure as a prognostic tool in pulmonary hypertension.”