Clinical Utility of Superior Vena Cava Flow Velocity Waveform Measured from the Subcostal Window for Estimating Right Atrial Pressure

Murayama, Michito; Kaga, Sanae; Okada, Kazunori; Iwano, Hiroyuki; Nakabachi, Masahiro; Yokoyama, Shinobu; Nishino, Hisao; Tsujinaga, Shingo; Chiba, Yasuyuki; Ishizaka, Suguru; Motoi, Ko; Kamiya, Kiwamu; Nishida, Mutsumi; Nagai, Toshiyuki; Anzai, Toshihisa

Clinical Utility of Superior Vena Cava Flow Velocity Waveform Measured from the Subcostal Window for Estimating Right Atrial Pressure

Murayama, Michito; Kaga, Sanae; Okada, Kazunori et al.

Journal of the American Society of Echocardiography, 2022, 35(7), 727-737

Permalink : https://hdl.handle.net/2115/90111

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アクセス権	open access
URI	https://hdl.handle.net/2115/90111
タイトル	Clinical Utility of Superior Vena Cava Flow Velocity Waveform Measured from the Subcostal Window for Estimating Right Atrial Pressure
著者	Murayama, Michito ; Kaga, Sanae ; Okada, Kazunori ; Iwano, Hiroyuki ; Nakabachi, Masahiro ; Yokoyama, Shinobu ; Nishino, Hisao ; Tsujinaga, Shingo ; Chiba, Yasuyuki ; Ishizaka, Suguru ; Motoi, Ko ; Kamiya, Kiwamu ; Nishida, Mutsumi ; Nagai, Toshiyuki ; Anzai, Toshihisa
著者名 Murayama, Michito
e-Rad_Researcher 60630978 著者名 Kaga, Sanae
著者名 Okada, Kazunori
e-Rad_Researcher 50622354 著者名 Iwano, Hiroyuki
著者名 Nakabachi, Masahiro
著者名 Yokoyama, Shinobu
著者名 Nishino, Hisao
e-Rad_Researcher 60844743 著者名 Tsujinaga, Shingo
著者名 Chiba, Yasuyuki
著者名 Ishizaka, Suguru
著者名 Motoi, Ko
e-Rad_Researcher 60797108 著者名 Kamiya, Kiwamu
e-Rad_Researcher 90404722 著者名 Nishida, Mutsumi
e-Rad_Researcher 00528218 著者名 Nagai, Toshiyuki
e-Rad_Researcher 60232089 著者名 Anzai, Toshihisa
言語	英語
キーワード	Echocardiography
	Right atrial pressure
	Right atrial pressure estimation
	Superior vena cava
	Subcostal approach
	Supraclavicular approach
発行日	2022-07-01
出版者	Elsevier
収録物名	Journal of the American Society of Echocardiography
巻(号)	35(7)
ページ	727-737
抄録	Background: The superior vena cava (SVC) flow velocity waveform from the supraclavicular window reflects right atrial pressure (RAP) status. Recent guidelines have stated that the subcostal window is an alternative view for recording SVC flow, but the validity of this approach remains unclear. The aim of this study was to determine the usefulness of SVC flow evaluation from the subcostal window for estimating RAP. Methods: Differences in SVC flow characteristics between opposite approaches were examined in 38 healthy adults. In 115 patients with cardiovascular diseases who underwent cardiac catheterization and echocardiography within 48 hours, the ratio of peak systolic to diastolic forward SVC flow (SVC-S/D) was measured, and the diagnostic ability of SVC-S/D for elevated RAP was tested. A validation cohort was used to confirm the diagnostic ability of SVC-S/D in 48 patients who underwent both cardiac catheterization and echocardiography within 24 hours. In 59 patients in the derivation and validation cohorts, the relationship between SVC flow and RAP was compared between the opposite windows. Results: Both systolic and diastolic SVC flow velocities were higher in the subcostal than in the supraclavicular approach, and effect of position change on subcostal SVC-S/D was smaller than that on supraclavicular SVCS/D in healthy adults. Measurement of SVC-S/D from the subcostal window was feasible in 98 patients (85%). RAP was inversely correlated with SVC-S/D (r = -0.50, P <.001) and was an independent determinant of SVCS/D after adjustment for right ventricular systolic function (beta = -0.48, P <.001). A cutoff value of 1.9 for SVC-S/D showed 85% sensitivity and 74% specificity in identifying elevated RAP. Additionally, SVC-S/D showed an incremental diagnostic value combined with inferior vena cava size and collapsibility (P =.006). When a cutoff value of SVC-S/D < 1.9 was applied to the validation cohort, it showed acceptable accuracy of 72% and incremental diagnostic value combined with inferior vena cava parameters (P =.033). SVC-S/D from the subcostal window correlated better with RAP than that from the supraclavicular window (P <.001, Meng's test). Conclusions: Measurement of SVC flow velocity from the subcostal window was feasible, and SVC-S/D from the subcostal window could be an additive parameter for estimating RAP.
資源タイプ	学術雑誌論文
出版タイプ	Accepted Manuscript
権利情報	Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
権利情報	© 2022. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
PISSN	0894-7317
関連情報	PMID 35150833
関連情報 (isVersionOf)	出版社版DOI https://doi.org/10.1016/j.echo.2022.02.002