Detection of elevated right atrial pressure using a simple bedside ultrasound measure

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Editor:

I read the recent publication by Simon et al¹ with a great interest. Simon et al concluded that “An increase in RIJV CSA >17% during Valsalva effectively rules out elevated RAP. This simple bedside technique may be useful to assess central venous pressure and reduce the need for invasive pressure measurement.”¹ I agree that the bedside ultrasound measure might be an alternative noninvasive technique for assessment of right atrial pressure. However, there are some concerns on the report by Simon et al.¹ The specificity of the test is poor, and the sensitivity is only fair. Hence, it is still questionable for the effectiveness of this alternative method for measurement of right atrial pressure. The problem of false-positive in the ultrasound for determining right heart stress is mentioned.² Similar to a previous report on the use of pulsatile lower limb venous Doppler waveform determintation,³ a good correlation to the right atrial pressure might be derived from internal jugular ultrasonography, but the poor diagnostic property might make this imaging approach unable to be used to screen for right-sided heart failure.

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References 

1. Simon MA, Kliner DE, Girod JP, et al. Detection of elevated right atrial pressure using a simple bedside ultrasound measure. Am Heart J. 2010;159:421–427
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2. Klopf D. Diagnosis of right heart stress with one- and two-dimensional echocardiography–sensible normal values, problems and limitations. Pneumologie. 1993;47:14–18
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3. Abu-Yousef MM, Kakish ME, Mufid M. Pulsatile venous Doppler flow in lower limbs: highly indicative of elevated right atrium pressure. AJR Am J Roentgenol. 1996;167:977–980
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