Non‐invasive measurement of right atrial pressure by near‐infrared spectroscopy: preliminary experience. A report from the SICA‐HF study. (6th April 2017)

• Record Type: Journal Article
• Authors: Pellicori, Pierpaolo; Clark, Andrew L.; Kallvikbacka‐Bennett, Anna; Zhang, Jufen; Urbinati, Alessia; Monzo, Luca; Dierckx, Riet; Anker, Stefan D.; Cleland, John G.F.
• Is Part Of: European journal of heart failure. Volume 19:Number 7(2017)
• Page Start: 883
• Page End: 892
• Publication Date: 2017-04-06
• Subjects: Heart failure -- Near‐infrared spectroscopy -- Right atrial pressure -- Prognosis; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.825
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: To assess the clinical value of measuring right atrial pressure (RAP) using near‐infrared spectroscopy (NIRS) in patients with chronic heart failure (CHF). Methods and results: RAP was measured non‐invasively using 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. 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 (NT‐proBNP ≤125 ng/L), RAP was 7 [interquartile range (IQR) 4–11] mmHg vs. 4 (IQR 3–8) mmHg ( P < 0.001). Those with RAP ≥10 mmHg ( n = 75) were older, had more severe clinical congestion and renal dysfunction, higher plasma NT‐proBNP, 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 follow‐up of 595 (IQR: 492–714) days, 49 patients (20%) died or were hospitalized for worsening CHF. Compared with patients with RAP ≤5 mmHg, those with RAP ≥10 mmHg had a greater risk of an event (hazard ratio 2.38, 95% confidence interval 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.