Non-invasive measurement of right atrial pressure by near-infrared spectroscopy: preliminary experience. A report from the SICA-HF study

Pellicori, Pierpaolo; Clark, Andrew L.; Kallvikbacka-Bennett, Anna; Zhang, Jufen; Urbinati, Alessia; Monzo, Luca; Dierckx, Riet; Anker, Stefan D.; Cleland, John G.F.

Abstract

Background: Jugular venous distension, reflecting raised right atrial pressure (RAP), is a classical sign of congestive heart failure (CHF), but its clinical assessment can be difficult. Methods: RAP was measured non-invasively using near-infrared spectroscopy (NIRS) over the external jugular vein (Venus 1000, Mespere LifeSciences, Canada) in ambulatory patients with CHF enrolled in the “Studies Investigating Co-morbidities Aggravating Heart Failure” (SICA-HF) programme. Results: Comparing 243 patients with CHF (mean age 71 years; mean left ventricular ejection fraction (LVEF) 45%, median NT-proBNP 788 ng/l) to 49 controls (NTproBNP < 125 ng/l), RAP was 7 (IQR: 4-11) versus 4 (IQR: 3-8) mmHg, p10 mmHg (N=75) were older, had more severe clinical congestion and renal dysfunction, higher plasma NTproBNP, larger left atrial volume, higher systolic pulmonary pressure and were more often in atrial fibrillation but their LVEF was similar to patients with lower RAP. During a median FU of 595 (IQR: 492-714) days, 49 patients (20%) died or were hospitalized for worsening CHF. Compared to patients with RAP 10 mmHg had a greater risk of an event (HR 2.38, 95% CI: 1.19-4.75, p=0.014). RAP measured by NIRS predicted outcome, competing with NT-proBNP in multivariable models. Conclusions: Measuring RAP using NIRS identifies ambulatory patients with CHF who have more severe congestion and a worse outcome. The device might be a useful objective method of monitoring RAP, especially for those inexperienced in eliciting physical signs or when measurement of natriuretic peptides is not immediately available.

Citation

Pellicori, P., Clark, A. L., Kallvikbacka-Bennett, A., Zhang, J., Urbinati, A., Monzo, L., Dierckx, R., Anker, S. D., & Cleland, J. G. (2017). Non-invasive measurement of right atrial pressure by near-infrared spectroscopy: preliminary experience. A report from the SICA-HF study. European journal of heart failure, 19(7), 883-892. https://doi.org/10.1002/ejhf.825

• Acceptance Date: Feb 28, 2017
• Online Publication Date: Apr 6, 2017
• Publication Date: 2017-07
• Deposit Date: Mar 8, 2017
• Publicly Available Date: Apr 10, 2018
• Journal: European journal of heart failure
• Print ISSN: 1388-9842
• Electronic ISSN: 1879-0844
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 7
• Pages: 883-892
• DOI: https://doi.org/10.1002/ejhf.825
• Keywords: Near-Infrared Spectroscopy; Right atrial pressure; Prognosis
• Public URL: https://hull-repository.worktribe.com/output/449214
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1002/ejhf.825/full
• Additional Information: This is the accepted manuscript of an article published in European journal of heart failure, 2017. The version of record is available at the DOI link in this record.
• Contract Date: Apr 10, 2018