Performances of Clinical, Biological and Echographic Signs to Assess Right Atrial Pressure in Pulmonary Hypertension

Background/Objectives: Right heart failure remains the leading cause of death in pulmonary hypertension. Early detection of right-sided congestion is crucial but relies largely on clinical signs with limited diagnostic accuracy. We performed a post hoc analysis of the CODOVEIN study to evaluate the diagnostic performance of clinical and non-invasive parameters for predicting elevated right atrial pressure (RAP). Methods: This post hoc analysis included patients from a prospective cross-sectional study who underwent right heart catheterization. Clinical signs, echocardiographic parameters, venous Doppler indices, and NT-proBNP levels were assessed within four hours before catheterization. Patients were stratified according to invasively measured RAP. Diagnostic performances were evaluated using sensitivity, specificity, predictive values, likelihood ratios, and ROC curves. Results: Several clinical and imaging parameters were associated with increasing RAP. Among non-invasive markers, the femoral venous stasis index (FVSI) and inferior vena cava (IVC) collapsibility assessed in transverse view showed the best discriminative ability for detecting RAP > 14 mmHg. FVSI demonstrated the highest positive likelihood ratio (>11) and an excellent negative predictive value (>0.98), outperforming other clinical and echocardiographic markers. Conclusions: In patients with pulmonary hypertension, FVSI provides robust non-invasive identification of right atrial pressure elevation and may complement traditional clinical assessment for the early detection of right-sided congestion.