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A Novel Method for Estimating Right Atrial Pressure With Point-of-Care Ultrasound

Background: Current noninvasive estimation of right atrial pressure (RAP) by either bedside jugular venous pressure exam or inferior vena cava measurement during a comprehensive echocardiogram offers imprecise estimates of actual RAP.

Methods: We enrolled 41 patients in a prospective, blinded study to validate a novel point-of-care ultrasound method using direct right atrial depth (RAD) measurement and jugular venous ultrasound to estimate RAP. Two subjects were excluded, and 39 were included in the final analysis. A parasternal long-axis view was obtained, and the depth of the noncoronary cusp attachment to the posterior left ventricular outflow tract was recorded as the RAD. This was added to an estimate of the jugular venous pressure obtained during a jugular vein ul- trasound to calculate an estimated RAP (RAPUS). The RAPUS was compared to the RAP measurement during right heart catheterization (RAPcath) both as measured and as corrected for where the catheter was zeroed.

Conclusion: This simple ultrasound evaluation of RAD and the right jugular vein correlates well with actual RAP and can accurately estimate RAP within 3 mm Hg in most patients. This has the potential to improve our bedside volume status exam, as well as improve the accuracy of RAP estimation during comprehensive echo- cardiogram.


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A Novel Method for Estimating Right Atrial Pressure With Point-of-Care Ultrasound
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