Correlation between right atrial pressure measured via right heart catheterization and venous excess ultrasound, inferior vena cava diameter, and ultrasound-measured jugular venous pressure: a prospective observational study

Background Venous congestion is associated with adverse cardiovascular outcomes, necessitating accurate venous pressure assessment. Current methods, such as right heart catheterization (RHC), have limitations. Non-invasive techniques, including venous excess ultrasound (VExUS), inferior vena cava (IVC) assessment, and ultrasound-measured jugular venous pressure (uJVP), show promise but require validation in diverse populations. Aims We aimed to assess the correlation between right atrial pressure (RAP) via RHC and non-invasive methods, including VExUS, IVC diameter with collapsibility index (CI) by American Society of Echocardiography (ASE) classification, and uJVP. Methods In a prospective study involving 73 patients undergoing RHC, we evaluated the correlation between RAP and VExUS, IVC CI by ASE classification, and uJVP. We introduced and compared a modified VExUS grading system. Results VExUS significantly correlated with RAP (p < 0.001), especially between VExUS grade 0 and grade 3. RAP significantly differed across IVC classifications by ASE (P < 0.001). VExUS grade 0 correlated with IVC class 1, and VExUS grade 3 correlated with IVC class 3. The modified VExUS grading system improved low and high RAP differentiation. uJVP exhibited a robust, highly significant positive correlation with invasively measured RAP (rho = 0.67, P < 0.001). Conclusion This study establishes a strong correlation between non-invasive ultrasound measurements (VExUS, IVC diameter with CI, and uJVP) and invasively measured RAP. These findings underscore the clinical potential of these non-invasive techniques in venous congestion assessment and patient risk stratification.