American Heart Journal
Volume 160, Issue 2 , Page e19, August 2010

Response to the letter regarding the article Detection of elevated right atrial pressure using a simple bedside ultrasound measure

Article Outline

 

We appreciate the comments regarding our recent publication.1 With any test, there are pros and cons as to its effectiveness. This is particularly true of noninvasive estimates of pressure, which have been a vexing problem in cardiovascular imaging. As we reported, the value of this test is in its simplicity and clear relation to vascular physiology. Dr Wiwanitkit has interpreted our conclusion that “An increase in RIJV CSA >17% during Valsalva rules out elevated RAP” means “specificity.” However, we are in fact referring to the negative predictive value, which, at 94%, is very powerful. We are uncertain as to how 90% sensitivity can be classified as only fair and 74% specificity as poor, but clearly this is open to interpretation. Test characteristics are a function of the cutoff value used; and for our report, there were actually very few false positives (Figure 3, right quadrant defined by right atrial pressure >12 mm Hg and RIJV CSA >17%) because we felt it important to err on the side of more false negatives and less false positives. Therefore, this test appears to be an advance from those mentioned by Dr Wiwanitkit.2, 3 We are continuing to evaluate this technique and hope to provide more data for discussion soon.

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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
  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
  3. Abu-Yousef MM, Kakish ME, Mufid M, et al. Pulsative venous Doppler flow in lower limbs: highly indicative of elevated right atrium pressure. AJR Am J Roentgenol. 1996;167:977–980

PII: S0002-8703(10)00436-9

doi:10.1016/j.ahj.2010.05.030

Refers to article:

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

    Viroj Wiwanitkit
    American Heart Journal August 2010 (Vol. 160, Issue 2, Page e17)

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

    Marc A. Simon, Dustin E. Kliner, John P. Girod, Diego Moguillansky, Flordeliza S. Villanueva, John J. Pacella
    American Heart Journal March 2010 (Vol. 159, Issue 3, Pages 421-427)

American Heart Journal
Volume 160, Issue 2 , Page e19, August 2010

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