TY - JOUR
T1 - Estimating right atrial pressure using upright computed tomography in patients with heart failure
AU - Fukuoka, Ryoma
AU - Yamada, Yoshitake
AU - Kataoka, Masaharu
AU - Yokoyama, Yoichi
AU - Yamada, Minoru
AU - Narita, Keiichi
AU - Nakahara, Takehiro
AU - Fukuda, Keiichi
AU - Jinzaki, Masahiro
N1 - Funding Information:
Masahiro Jinzaki has received a grant from Canon Medical Systems. However, Canon Medical Systems was not involved in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, and approval of the manuscript. Other authors have no conflicts of interest to disclose.
Funding Information:
This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (grant numbers JP17K16482 and JP20K08056 [Yoshitake Yamada]) and the Takeda Science Foundation (Yoshitake Yamada).
Publisher Copyright:
© 2022, The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - Objectives: Upright computed tomography (CT) can detect slight changes particularly in the superior vena cava (SVC) volume in healthy volunteers under the influence of gravity. This study aimed to evaluate whether upright CT-based measurements of the SVC area are useful for assessing mean right atrial pressure (mRAP) in patients with heart failure. Methods: We performed CT in both standing and supine positions to evaluate the SVC (directly below the junction of the bilateral brachiocephalic veins) and inferior vena cava (IVC; at the height of the diaphragm) areas and analyzed their relationship with mRAP, measured by right heart catheterization in 23 patients with heart failure. Results: The median age of enrolled patients was 60 (51−72) years, and 69.6% were male. The median mRAP was 3 (1−7) mmHg. The correlations between the standing position SVC and IVC areas and mRAP were stronger than those in the supine position (SVC, ρ = 0.68, p < 0.001 and ρ = 0.43, p = 0.040; IVC, ρ = 0.57, p = 0.005 and ρ = 0.46, p = 0.026; respectively). Furthermore, the SVC area in the standing position was most accurate in identifying patients with higher mRAP (> 5 mmHg) (SVC standing, area under the receiver operating characteristic curve [AUC] = 0.91, 95% confidence interval [CI], 0.77–1.00; SVC supine, AUC = 0.78, 95% CI, 0.59–0.98; IVC standing, AUC = 0.77, 95% CI, 0.55–0.98; IVC supine, AUC = 0.72, 95% CI, 0.49–0.94). The inter- and intraobserver agreements (evaluated by intraclass correlation coefficients) for all CT measurements were 0.962–0.991. Conclusions: Upright CT-based measurement of the SVC area can be useful for non-invasive estimation of mRAP under the influence of gravity in patients with heart failure. Key Points: • This study showed that the superior vena cava (SVC) area in the standing position was most accurate in identifying patients with heart failure with higher mean right atrial pressure. • Upright computed tomography-based measurements of the SVC area can be a promising non-invasive method for estimating mean right atrial pressure under the influence of gravity in patients with heart failure. • Clinical management of patients with heart failure based on this non-invasive modality may lead to early assessment of conditional changes and reduced hospitalization for exacerbation of heart failure.
AB - Objectives: Upright computed tomography (CT) can detect slight changes particularly in the superior vena cava (SVC) volume in healthy volunteers under the influence of gravity. This study aimed to evaluate whether upright CT-based measurements of the SVC area are useful for assessing mean right atrial pressure (mRAP) in patients with heart failure. Methods: We performed CT in both standing and supine positions to evaluate the SVC (directly below the junction of the bilateral brachiocephalic veins) and inferior vena cava (IVC; at the height of the diaphragm) areas and analyzed their relationship with mRAP, measured by right heart catheterization in 23 patients with heart failure. Results: The median age of enrolled patients was 60 (51−72) years, and 69.6% were male. The median mRAP was 3 (1−7) mmHg. The correlations between the standing position SVC and IVC areas and mRAP were stronger than those in the supine position (SVC, ρ = 0.68, p < 0.001 and ρ = 0.43, p = 0.040; IVC, ρ = 0.57, p = 0.005 and ρ = 0.46, p = 0.026; respectively). Furthermore, the SVC area in the standing position was most accurate in identifying patients with higher mRAP (> 5 mmHg) (SVC standing, area under the receiver operating characteristic curve [AUC] = 0.91, 95% confidence interval [CI], 0.77–1.00; SVC supine, AUC = 0.78, 95% CI, 0.59–0.98; IVC standing, AUC = 0.77, 95% CI, 0.55–0.98; IVC supine, AUC = 0.72, 95% CI, 0.49–0.94). The inter- and intraobserver agreements (evaluated by intraclass correlation coefficients) for all CT measurements were 0.962–0.991. Conclusions: Upright CT-based measurement of the SVC area can be useful for non-invasive estimation of mRAP under the influence of gravity in patients with heart failure. Key Points: • This study showed that the superior vena cava (SVC) area in the standing position was most accurate in identifying patients with heart failure with higher mean right atrial pressure. • Upright computed tomography-based measurements of the SVC area can be a promising non-invasive method for estimating mean right atrial pressure under the influence of gravity in patients with heart failure. • Clinical management of patients with heart failure based on this non-invasive modality may lead to early assessment of conditional changes and reduced hospitalization for exacerbation of heart failure.
KW - Atrial pressure
KW - Heart failure
KW - Multidetector computed tomography
KW - Standing position
KW - Superior vena cava
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U2 - 10.1007/s00330-022-09360-8
DO - 10.1007/s00330-022-09360-8
M3 - Article
C2 - 36576542
AN - SCOPUS:85145029538
SN - 0938-7994
VL - 33
SP - 4073
EP - 4081
JO - European Radiology
JF - European Radiology
IS - 6
ER -