Echocardiographic RV-E/e’ for predicting right atrial pressure: a review

in Echo Research and Practice
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  • 1 A Fletcher, Cardiac Physiology, Papworth Hospital NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom of Great Britain and Northern Ireland
  • 2 S Robinson, Cardiac Investigations, North West Anglia NHS Foundation Trust, Peterborough, United Kingdom of Great Britain and Northern Ireland
  • 3 B Rana, Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland

Correspondence: Andrew Fletcher, Email:

Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and prognostic significance, yet current two-dimensional echocardiographic methods are inadequate for the accurate estimation of this haemodynamic marker. Right-heart trans-tricuspid Doppler and tissue Doppler echocardiographic techniques can be combined to calculate the right ventricular (RV) E/e’ ratio – a reflection of RV filling pressure which is a surrogate of RAP. A systematic search was undertaken which found seventeen articles that compared invasively measured RAP with RV-E/e’ estimated RAP. Results commonly concerned pulmonary hypertension or advanced heart failure/transplantation populations. Reported receiver operator characteristic analyses showed reasonable diagnostic ability of RV-E/e’ for estimating RAP in patients with coronary artery disease and RV systolic dysfunction. The diagnostic ability of RV-E/e’ was generally poor in studies of paediatrics, heart failure and mitral stenosis, whilst results were equivocal in other diseases. Bland-Altman analyses showed good accuracy but poor precision of RV-E/e’ for estimating RAP, but were limited by only being reported in seven out of seventeen articles. This suggests that RV-E/e’ may be useful at a population level but not at an individual level for clinical decision making. Very little evidence was found about how atrial fibrillation may affect the estimation of RAP from RV-E/e’, nor about the independent prognostic ability of RV-E/e’ . Recommended areas for future research concerning RV-E/e’ include; non-sinus rhythm, valvular heart disease, short and long term prognostic ability, and validation over a wide range of RAP.

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    British Society of Echocardiography

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