Right atrial strain: Tapping into a new reservoir of hemodynamic information

Fluid retention is one of the hallmarks of heart failure (HF), and important to recognize to guide clinical management [ [1] Ponikowski P. Voors A.A. Anker S.D. Bueno H. Cleland J.G.F. Coats A.J.S. Falk V. González-Juanatey J.R. Harjola V.-P. Jankowska E.A. Jessup M. Linde C. Nihoyannopoulos P. Parissis J.T. Pieske B. Riley J.P. Rosano G.M.C. Ruilope L.M. Ruschitzka F. Rutten F.H. van der Meer P. ESC Scientific Document Group 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016; 37: 2129-2200 Crossref PubMed Scopus (6612) Google Scholar ]. Congestion can in many cases be relieved with diuretics and identifying underlying causes of congestion may also help guide further diagnostic evaluation. Clinical evaluation of elevated right atrial pressure (RA) has historically been made through careful consideration of the jugular veins [ [2] Borst J.G.G. Molhuysen J.A. Exact determination of the central venous pressure by a simple clinical method. Lancet. 1952; : 304-309 Abstract PubMed Scopus (20) Google Scholar ], however, this comes with questionable reproducibility [ [1] Ponikowski P. Voors A.A. Anker S.D. Bueno H. Cleland J.G.F. Coats A.J.S. Falk V. González-Juanatey J.R. Harjola V.-P. Jankowska E.A. Jessup M. Linde C. Nihoyannopoulos P. Parissis J.T. Pieske B. Riley J.P. Rosano G.M.C. Ruilope L.M. Ruschitzka F. Rutten F.H. van der Meer P. ESC Scientific Document Group 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016; 37: 2129-2200 Crossref PubMed Scopus (6612) Google Scholar ]. Accurate measurement of RA pressure can be made by right heart catheterization (RHC), however, this should be reserved for when clinically necessary given its invasive nature. Accordingly, non-invasive tools for the assessment of RA pressure are warranted. At the crossroad between jugular venous pressure evaluation and RHC, echocardiography has emerged. This imaging tool serves as an invaluable ally for guiding diagnosis, prognosis, and management in HF [ [1] Ponikowski P. Voors A.A. Anker S.D. Bueno H. Cleland J.G.F. Coats A.J.S. Falk V. González-Juanatey J.R. Harjola V.-P. Jankowska E.A. Jessup M. Linde C. Nihoyannopoulos P. Parissis J.T. Pieske B. Riley J.P. Rosano G.M.C. Ruilope L.M. Ruschitzka F. Rutten F.H. van der Meer P. ESC Scientific Document Group 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 2016; 37: 2129-2200 Crossref PubMed Scopus (6612) Google Scholar ]. Diagnostic utility of right atrial reservoir strain to identify elevated right atrial pressure in heart failureInternational Journal of CardiologyVol. 324PreviewAccurate non-invasive estimation of right atrial pressure (RAP) is essential to assess volume status and optimize therapy in heart failure (HF). This study aimed to evaluate the utility of right atrial reservoir strain (RASr) assessed by speckle-tracking echocardiography to identify elevated RAP in HF and compare diagnostic performance with estimated RAP employing inferior vena cava size and collapsibility (RAPIVC), in addition to RA area. Full-Text PDF