Long-term prognostic implications of right atrial pressure measured during emergency hemodynamic assessment
H Sato, T Ohta, K Hiroe, N Yamaguchi, K Matsuda, T Ohshima, T Nakamura, S Okada, K TanabeAbstract
Background
Although right atrial pressure (RAP) is routinely measured during right heart catheterization (RHC), its prognostic significance in emergency or urgent clinical settings has not been fully elucidated.
Purpose
This study aimed to investigate the association between RAP measured during emergency or urgent RHC and long-term clinical outcomes.
Methods
This retrospective, single-center, cohort study included 3,200 consecutive patients (median age: 73 [range: 21–106] years; 61.8% male) who underwent emergency or urgent RHC at our Hospital between January 2005 and December 2023. RAP was assessed at the time of RHC, and patients were stratified according to a cut-off value of 8 mmHg, corresponding to the upper limit of the normal range. The primary outcome was the all-cause mortality rate. Survival analyses were performed using the Kaplan–Meier method with the log-rank test and Cox proportional hazards models, which were adjusted for baseline clinical and hemodynamic variables.
Results
The primary diagnoses were acute coronary syndrome (85.5%), decompensated heart failure (7.5%), and other cardiovascular diseases. The median RAP was 7 (range:0-30) mmHg. Five-year freedom from all-cause mortality was significantly higher in the low RAP group than in the high RAP group (96.8% vs. 79.8%; log-rank p<0.0001). After multivariable adjustment for demographic characteristics, comorbidities, and hemodynamic parameters, elevated RAP was independently associated with increased mortality (adjusted hazard ratio: 2.59; 95% confidence interval: 2.08–3.02; p<0.0001).
Conclusions
In patients undergoing emergency or urgent RHC, RAP is an independent predictor of long-term survival. RAP may provide a simple, clinically useful tool for risk stratification in acute cardiovascular care settings.For image description, please refer to the figure legend and surrounding text.