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\begin{document}

\title{USING CORONARY SINUS DIAMETER AND COLLAPSE INDEX TO ESTIMATE RIGHT
ATRIAL PRESSURE FOR ECHOCARDIOGRAPHIC SYSTOLIC PULMONARY ARTERIAL
PRESSURE MEASUREMENT}



\author[1]{GÜNDÜZALP SAYDAM}%
\author[2]{Ali Kilinc}%
\author[3]{Veysel Tosun}%
\author[1]{Necmettin Korucuk}%
\author[4]{Unal Guntekin}%
\author[5]{mehmet yaman}%
\affil[1]{Affiliation not available}%
\affil[2]{Arnavutköy State Hospital}%
\affil[3]{Sanliurfa Egitim ve Arastirma Hastanesi}%
\affil[4]{Akdeniz Universitesi Tip Fakultesi}%
\affil[5]{Ordu Universitesi}%


\vspace{-1em}



  
  \date{June 16, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Objective: According to Bernoulli Equation, systolic pulmonary artery
pressure is obtained echocardiographically by adding estimated right
atrial pressure (RAP) to the multiply of square of tricuspid
regurgitation flow rate by four. RAP is estimated based on inferior vena
cava (IVC) diameter and collapse. Our objective is to investigate
usability of coronary sinus(CS) diameter and collapse, measured by
echocardiography for estimating RAP. Methods: Our study is a single
center, prospective study. 136 patients, over 18 years of age and
without exclusion criteria, who admitted to Akdeniz University Hospital
Cardiology Department between March 2017 and March 2018 and were
scheduled to undergo right heart catheterization for any reason were
included study. Results: Patients were divided into two groups as
invasively measured RAP [?]10 mmHg (n: 57) and RAP \textless{}10 mmHg (n:
79). In group with RAP [?]10 mmHg, maximum IVC and CS diameter were higher
than group with RAP \textless{}10 mmHg, IVC and CS collapse indices were
lower (p \textless{}0.001). Optimal cut-off value for maximum IVC
diameter was 19.6 mm (sensitivity 63.2\%, specificity 87.3\%), for IVC
collapse index was 46.1 (sensitivity 75\%, specificity 79.7\%), for
maximum CS diameter was 11 mm (sensitivity 64.9\%, specificity 77\%),
for CS collapse index was 39.2 (sensitivity 75.4\%, specificity 88.6\%).
Conclusion: Significant relationship was found between invasively
measured RAP and maximum IVC diameter, collapse index and maximum CS
diameter and collapse index. Results of CS parameters were as
significant as results of IVC parameters therefore it shows that CS can
also be used for estimating RAP.%
\end{abstract}%



\sloppy


\textbf{USING CORONARY SINUS DIAMETER AND COLLAPSE INDEX TO ESTIMATE
RIGHT ATRIAL}

\textbf{PRESSURE FOR ECHOCARDIOGRAPHIC SYSTOLIC PULMONARY ARTERIAL
PRESSURE}

\textbf{MEASUREMENT}

G\selectlanguage{ngerman}ündüzalp Saydam\textsuperscript{1}, Ali Ya\selectlanguage{polish}ş\selectlanguage{english}ar
K\selectlanguage{polish}ı\selectlanguage{english}l\selectlanguage{polish}ı\selectlanguage{english}n\selectlanguage{ngerman}ç\textsuperscript{2}, Veysel Tosun\textsuperscript{3}, Necmettin
Korucuk\textsuperscript{4}, Ünal Güntekin\textsuperscript{5}, Mehmet
Yaman\textsuperscript{6}

\textsuperscript{1} Cihanbeyli State Hospital, Cardiology Department,
Konya, Turkey

\textsuperscript{2} Arnavutköy State Hospital, Cardiology Department,
Istanbul, Turkey

\textsuperscript{3} \selectlanguage{polish}Ş\selectlanguage{english}anl\selectlanguage{polish}ı\selectlanguage{english}urfa Training and Research Hospital, Cardiology
Department, \selectlanguage{polish}Ş\selectlanguage{english}anl\selectlanguage{polish}ı\selectlanguage{english}urfa, Turkey

\textsuperscript{4} Antalya Memorial Hospital, Cardiology Department,
Antalya, Turkey

\textsuperscript{5} Akdeniz University Medical Faculty Hospital,
Cardiology Department, Antalya, Turkey

\textsuperscript{6} Ere\selectlanguage{polish}ğ\selectlanguage{english}li Echomar Hospital, Cardiology Department,
Zonguldak, Turkey

\textbf{Corresponding Author:} G\selectlanguage{ngerman}ündüzalp Saydam, Cihanbeyli State
Hospital, Cardiology Department

\textbf{Address:} Atçeken \textbf{Neighborhood} , Hastane Street, 42850
Cihanbeyli / Konya

\textbf{Mail:} gunduzalpsaydam@gmail.com

\textbf{Tel No:} 0536 743 41 82

\textbf{Fax No:} 0332 673 40 95

The authors have no conflict of interest declare.

No financial support was received for the study.

\textbf{Introduction}

Pulmonary hypertension (PHT) is a disease characterized by complex
proliferation and progressive pulmonary vascular remodeling in the
pulmonary vascular endothelium (1). With use of transthoracic
echocardiography(TTE), it has become possible to estimate pulmonary
artery pressure(PAP) by a noninvasive method. According to Bernoulli
Equation, systolic PAP is obtained by adding estimated right atrial
pressure (RAP) to the multiply of square of tricuspid regurgitation(TR)
flow rate by four (2). When the estimated RAP is added to the
transtricuspid gradient, calculated using the maximum jet of TR, the
calculated values are very close to the values of right ventricular(RV)
systolic pressure measured by right heart catheterization(RHC) (3).
Estimated RAP is determined by TTE based on inferior vena cava (IVC)
diameter and collapse.

Normal value of RAP is 1-7 mmHg (4). RAP is most commonly estimated
according to IVC diameter and inspiratory collapse (5). As RAP
increases, this increase is transmitted to IVC, resulting in IVC
dilatation and reduction of inspiratory collapse. With the combination
of these two parameters, we can predict RAP in most patients.

Both IVC and coronary sinus(CS) open directly into the right atrium(RA).
CS is a tubular structure that draws a route in the atrioventricular
groove located at the posterior of the heart and where large cardiac
veins are poured. The diameter of the ostium varies between 4-5 mm and
9-15 mm(6). Echocardiographically, CS is best evaluated in apical
four-chamber imaging (7).

There are some studies evaluating the relationship of RAP, estimated by
non-invasive methods and systolic PAP with CS(8,9). However, there is no
study comparing invasively measured RAP with CS diameter and collapse
and evaluating the utility of CS in noninvasive RAP estimation. The aim
of our study is to evaluate the utility of CS diameter and collapse,
which is a noninvasive method, for estimating RAP. In this way, new
echocardiographic parameters will be defined for estimating RAP and PAP
value will be determined more accurately and easily.

\textbf{Methods}

136 patients over the age of 18, who admitted to Akdeniz University
Hospital Cardiology Department between March 2017 and March 2018 and
were scheduled to undergo right heart catheterization(RHC) for any
reason were included the study. Patients with congenital heart disease,
who had undergone surgery due to congenital heart disease in childhood,
whose echocardiographic evaluations could not be made due to poor
echogenicity and patients with missing RHC data were excluded from the
study.

Each individual included in the study was informed about the study and a
written consent form was read and signed. The study protocol was
approved by the local ethics committee and was performed in accordance
with the Declaration of Helsinki.

RAP, RV end-diastolic pressure, RV systolic pressure, PA pressures
(systolic, mean, diastolic) and pulmonary capillary wedge pressure
(PCWP) were measured by RHC. Measurements were evaluated at the end of
expiration.

Echocardiographic examinations of the patients were performed by an
experienced specialist at the Echocardiography Laboratory of the Akdeniz
University Cardiology Department. The patients were placed in the left
lateral decubitus position. Echocardiographic evaluations were performed
in the presence of electrocardiographic rhythm monitoring. Standard
two-dimensional echocardiography, M-mode echocardiography and doppler
examinations were performed through apical, parasternal and subcostal
windows in accordance with the recommendations of the American
Echocardiography Society. Parameters were taken in accordance with these
guideline recommendations and relevant measurements were calculated
according to these guideline recommendations (10). The CS diameter was
visualized in the posterior region between LA and LV, with a slight
posterior tilting of the probe at the level of the mitral annulus in
apical 4-chamber window. Maximum and minimum diameter of CS was measured
by M-Mode echocardiography method (Figure-1). CS collapse index (CSCI)
was calculated by the following formula:

= \% {[}(CSDmax -- CSDmin){]} / CSDmax x 100 CSDmax: Maximum CS
diameter, CSDmin: minimum CS diameter

IVC measurements were made through a standard subcostal
echocardiographic window. The intrahepatic region where IVC joins to the
RA was visualized. After expiration, IVC' s maximum diameter, minimum
diameter and respiratory change were measured 1-2 cm near the point
where the IVC joins the RA. IVC collapse index (IVCCI) was calculated by
the following formula:

= \% {[}(IVCDmax -- IVCDmin){]} / IVCDmax x 100

IVCDmax: Maximum IVC diameter, IVCDmin: minimum IVC diameter

Body surface areas (BSA) of the patients were calculated and CS and IVC
parameters were also analyzed by indexing with BSA.

Descriptive statistics are presented with mean, percentage and standard
deviation values. Fisher's Exact Test or Pearson's chi-square test was
used in the analysis of the relationships between categorical variables.
In the analysis of the difference between the measurement values of the
two groups, Mann-Whitney U test was used when the distribution of the
data did not comply with the normal distribution and Student's t test
was used if it did. Spearman correlation test was used for continuous
variables not conforming to ordered or normal distribution and Pearson
correlation test was used for continuous variables that conforming to
normal distribution. p values less than 0.05 were considered
statistically significant. In order to estimate the increase in RAP
measured by catheterization, ''Receiver-Operating Characteristic (ROC)''
curves were created for each IVC and CS parameter and optimal cut-off
values were determined from them. In addition, sensitivity, specificity,
positive and negative predictive values were found for the increased RAP
value. Study data were analyzed in ''MedCalc'' and ''SPSS 25.0 for
Windows'' programs.

\textbf{Results}

136 patients, whose TTE and RHC data were analyzed were included in the
study. The mean age of the patients included in the study was 57.67 ±
13.36 and 59 (43.4\%) patients were male. General characteristics,
clinical features, TTE and RHC findings of the patients are shown in
Table-1. IVCDmax, IVCDmin and IVCCI values were 18.5 mm, 11.14 mm,
42.41\%, respectively. CSDmax, CSDmin and CSCI values were 11.46 mm,
6.92 mm, 40.58\%, respectively.

The average RAP was measured as 9.84 ± 5.39 mmHg. In 57 patients,
invasively measured RAP was \selectlanguage{english}[?]10 mmHg, in 79 patients RAP was
\textless{}10 mmHg. In the group with RAP \selectlanguage{english}[?]10 mmHg, the diameters of IVC
and CS and their diameters indexed to BSA were higher than the group
with RAP \textless{}10 mmHg. In addition, in the group with RAP\selectlanguage{english}[?]10 mmHg,
IVCCI and CSCI and collapse indices indexed to BSA were lower. All
parameters were statistically significant (p \textless{}0.001)(Table-2).

CS and IVC parameters of the patients included in the study were
compared with each other as well as with invasively measured RAP values
and the correlation between them was evaluated. CSDmax and CSDmax/BSA
were compared with IVCDmax and IVCDmax/BSA and a moderate relationship
was found between them(r: 0.554 p \textless{}0.001; r: 0.597 p
\textless{}0.001, respectively). CSDmin, CSDmin/BSA and CSCI were
compared with IVCDmin, IVCDmin/BSA and IVCCI and a high level of
significant relationship was found between them(r: 0.712 p
\textless{}0.001; r: 0.717 p \textless{} 0.001; r: 0.608 p
\textless{}0.001 respetively)(Figure-2).

Invasively measured RAP was compared with CSDmax and CSDmax/BSA and a
moderate significant correlation was found between them (r: 0.478 p
\textless{}0.001; r: 0.484 p \textless{}0.001, respectively). Invasively
measured RAP was compared with CSDmin, CSDmin/BSA and CSCI and a high
level of significant relationship was found between them(r: 0.711 p
\textless{}0.001; r: 0.691 p \textless{}0.001; r: -0.674 p
\textless{}0.001, respectively)(Figure-3).

There was a moderately significant relationship between RAP and IVCDmax
and IVCDmax/BSA(r: 0.615 p \textless{}0.001, r: 0.518 p
\textless{}0.001). Finally, there was a high level of significant
correlation between RAP and IVCDmin, IVCDmin/BSA and IVCCI (r: 0.705 p
\textless{}0.001; r: 0.659 p, \textless{}0.001; r:-0.683 p
\textless{}0.001respectively)(Figure-4).

According to ROC analysis; for predicting RAP\selectlanguage{english}[?]10 mmHg, optimal cut-off
value of IVCDmax was found to be 19.6 mm (sensitivity, 63.2\%;
specificity, 87.3\%), optimal cut-off value of IVCDmax/BSA was found to
be 10,6 mm/m2 (sensitivity, \%64,9; specificity,\%81), optimal cut-off
value of IVCDmin was found to be 10 mm (sensitivity, \%73,7;
specificity,\%82,3), optimal cut-off value of IVCDmin/BSA was found to
be 5,8 mm/m2 (sensitivity, \%68,4; specificity, \%87,3), optimal cut-off
value of IVCCI was found to be 46,1 (sensitivity, \%75,4; specificity,
\%79,7), optimal cut-off value of CSDmax was found to be 11 mm
(sensitivity, \%64,9; specificity, \%77,3), optimal cut-off value of
CSDmax/BSA was found to be 5,8 mm/m2 (sensitivity, \%77,1;
specificity,\%58,2), optimal cut-off value of CSDmin was found to be 6,1
mm (sensitivity, \%84,2; specificity, \%77,2), optimal cut-off value of
CSDmin/BSA was found to be 3,6 mm/m2 (sensitivity, \%78,9;
specificity,\%79,7), optimal cut-off value of CSCI was found to be 39,2
(sensitivity, \%75,4; specificity, \%88,6). All parameters were
statistically significant (p \textless{}0.001)(Table-3).

\textbf{Discussion}

In our study, we evaluated the relationship between RA pressure,
measured by RHC and IVC, CS diameters and their collapse. It is known
that IVC diameter and collapse are used to predict RA pressure(11).
However, there is no data on the use of CS diameter and collapse to
predict RA pressure. There are a number of studies evaluating CS
diameter and collapse in PHT, but there is no study evaluating the
relationship between invasively measured RAP and CS.

In our study, the patients were divided into two groups as the group
with invasively measured RAP values of 10 mmHg and / or above and below
10 mmHg. The group with RAP\selectlanguage{english}[?]10 mmHg consisted of 57 individuals and the
group with RAP \textless{}10 mmHg comprised 79 individuals. It was
observed that the CSDmax and CSDmin were higher and CSCI was lower in
the group with RAP \selectlanguage{english}[?]10 mmHg. This difference has reached statistical
significance (p\textless{}0.001). In addition, we noticed that the
results did not change when we indexed CS parameters to BSA. In
addition, correlations of invasive RAP and CS parameters were evaluated
and a significant correlation was found between them.

We examined the relationship between IVC diameter, collapse index and
RAP and it was seen that IVC diameters were higher and IVC collapse
indices were low in the group with RAP \selectlanguage{english}[?]10 mmHg (p\textless{}0.001).
Again, the analysis of the data obtained by indexing these parameters to
BSA did not change the results. In previous studies comparing invasive
RAP and IVC parameters, a moderate correlation was found between the two
parameters (r: 0.35-0.76) (10,12). Similar to previous studies, in our
study, a significant correlation was found between IVCDmax, IVCDmin and
IVCCI parameters and invasive RAP.

In our study, unlike the studies in the literature, the correlations of
IVC and CS parameters with each other were evaluated. It was observed
that there was a significant correlation in all IVC and CS parameters
(maximum and minimum diameter, collapse index). The correlation
coefficient for the maximum IVC and CS diameter was 0.554, and the
correlation coefficient for the IVC and CS collapse index was 0.608.

In our study, we determined cut-off values predicting RAP to be 10 mm Hg
and above using ROC analysis for both IVC and CS. The cut-off values
stated in the guidelines and used in estimating RAP are 21 mm for IVC
diameter and 50\% for IVCCI (10,11). In a study by Kawata et al. In
2017, invasive RAP and echocardiographic IVC parameters were analyzed in
120 patients. The cut-off values, sensitivity and specificity of IVC
parameters predicting RAP\textgreater{} 10 mmHg were determined. The
cut-off value for IVCDmax was found to be 17 mm, and the cut-off value
for IVCCI was found to be 40\% (13). When we invastigated the
correlation of invasive RAP with IVCDmax and IVCCI, the correlation
coefficients in our study were higher. We found the cut-off values for
IVCDmax and IVCCI lower than the values in the guidelines (19.6 mm,
46.1\% respectively). The cut-off values we obtained for the CSDmax and
CSCI were 11 mm and 39.2\% respectively. In previous studies, no cut-off
value was specified for CS to predict RAP\selectlanguage{english}[?]10 mmHg. Our study is the
first study on this subject.

In a study in the literature, 155 patients included in the study were
divided into 3 groups as patients with no PHT, moderate PHT and severe
PHT. It was observed that as the systolic PAP value increased, CS
dilation increased (p \textless{}0.001) and a significant correlation
was found between CS and IVC (r: 0.416; p \textless{}0.001) (14). The
results in our study were similar and the correlation coefficient
between IVC and CS was found to be higher (r:0,554, p\textless{}0,001).

In our study, the correlation between invasively measured RAP and
estimated RAP calculated by IVC was also examined and found to be highly
significant (r: 0.765, p \textless{}0.001). This high correlation of the
estimated RAP with the invasively measured RAP reveals the reliability
of the echocardiography examination we have made.

In a study conducted with 215 people, the systolic PAPs of the patients
were calculated according to the Bernoulli equation with
echocardiography. The patients were divided into two groups as those
with systolic PAP above 35 mmHg (n: 109) and those without. CS diameters
were higher in the PHT group (p \textless{}0.001). At the same time, the
estimated RAP values were calculated according to the IVC diameter and
collapse of the patients. The correlation of RAP, calculated by IVC,
with the maximum diameter of the CS was examined and found to be
statistically significant (r = 0.557, P \textless{}0.001) (9). In our
study, pressures were measured invasively and it was observed that the
diameter of the CS was more dilated in patients with high invasive
pressures. It was observed that both the estimated RAP calculated by IVC
and the invasively measured RAP were correlated with the CS parameters.
In addition, differently, maximum diameters, minimum diameters, CS
collapse index and their ratio to BSA were evaluated and all of them
were found to be statistically significant.

In a study of 43 people conducted by Mahmud et al. in 2001, RA pressures
were measured invasively and compared with the minimum CS diameter
measured from the parasternal long axis and significant results were
obtained (r: 0.59, P \textless{}0.001) (15). In our study, IVCDmin was
found to be higher in the group with high invasive RAP. In addition, in
our study, ROC analyzes were performed for CSDmax, CSDmin, CSDmax/BSA,
CSDmin/BSA and CSCI in order to predict RAP \selectlanguage{english}[?]10 mmHg and their
sensitivity and specificity were calculated and optimal cut-off values
were determined. All CS parameters including CSDmin have been shown to
be useful for RAP estimation.

\textbf{Limitation of Study}

Our study is a single center study. Most of the patients included in the
study were people with cardiac disease, so no comparison could be made
with healthy individuals. RHC and TTE were not performed simultaneously.
There was a period of up to 48 hours between the two. Finally, the study
population was relatively small. Multicenter studies with higher
populations are needed on this subject.

\textbf{Conclusion}

Our study is the first catheterization-supported study on the use of CS
diameters and collapse in RAP estimation. IVC and CS parameters were
evaluated with invasively measured RAP and significant results were
obtained. That CS parameters are as significant as IVC parameters, shows
that CS can now be used in RAP estimation. The high level of
significance of correlation analyzes further strengthens this idea.
Cut-off values for CS parameters have been determined in our study and
will be an example for future studies.

\textbf{References}

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\textbf{Tables and Figures}\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
\begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
\textbf{Variable}\strut
\end{minipage} & \begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
\textbf{n:136}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Age (years)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
57,67\selectlanguage{ngerman}±13,36\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Male (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
59 (43,4)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{BMI (kg/ m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
27,81\selectlanguage{ngerman}±5,27\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{BSA ( m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
1,83\selectlanguage{ngerman}±0,19\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Systolic Blood Pressure (mmHg)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
125,92\selectlanguage{ngerman}±20,56\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Diastolic Blood Pressure (mmHg)}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
72,86\selectlanguage{ngerman}±9,95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Comorbidities}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Diabetes Mellitus (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
43(31,6)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Hypertension (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
68(50)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Ischemic Heart Disease (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
36(26,5)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Atrial Fibrillation (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
50(36,8)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Smoking (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
33(24,3)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Lung Disease (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
16(11,8)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Hemodynamic Data}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
PASP (mmHg)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
49,22\selectlanguage{ngerman}±22,86\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
PADP (mmHg)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
21,64\selectlanguage{ngerman}±9,96\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
PAMP (mmHg)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
32,9\selectlanguage{ngerman}±13,49\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
HR (beats/min)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
81,43\selectlanguage{ngerman}±13,75\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
RAP (mmHg)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
9,84\selectlanguage{ngerman}±5,39\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
RAP \selectlanguage{english}[?]10 mmHg (n(\%))\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
57(41,9)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\textbf{Ultrasound Data}\strut
\end{minipage} & \begin{minipage}[t]{0.47\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
IVCDmax (mm)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
18,5\selectlanguage{ngerman}±4,94\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
IVCDmin (mm)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
11,14\selectlanguage{ngerman}±5,62\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
IVCDmax/BSA (mm/m²)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
10,2\selectlanguage{ngerman}±2,73\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
IVCDmin/BSA (mm/m²)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
6,12\selectlanguage{ngerman}±2,98\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
IVCCI (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
42,41\selectlanguage{ngerman}±13,95\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
CSDmax (mm)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
11,46\selectlanguage{ngerman}±2,48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
CSDmin (mm)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
6,92\selectlanguage{ngerman}±2,39\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
CSDmax/BSA (mm/m²)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
6,32\selectlanguage{ngerman}±1,4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
CSDmin/BSA (mm/m²)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
3,8\selectlanguage{ngerman}±1,25\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
CSCI (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
40,58\selectlanguage{ngerman}±11,05\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}\selectlanguage{ngerman}

\textbf{Table-1:} General Characteristics, Hemodynamic and Ultrasound
Data of the Study Patients

BMI donates body mass index, BSA:body surface area, CS:coronary sinus,
CSD:coronary sinus diameter, CSCI:coronary sinus collapsibility index,
HR:heart rate, IVC:inferior vena cava, IVCCI:inferior vena cava
collapsibility index, IVCD:inferior vena cava diameter, PADP: pulmonary
artery diastolic pressure, PAMP:pulmonary artery mean pressure,
PASP:pulmonary artery systolic pressure, RAP:right atrial pressure.

\textbf{Tablo-2:} Comparison of IVC and CS parameters in the groups with
RAP\selectlanguage{english}[?]10 mmHg and RAP \textless{}10 mmHg\selectlanguage{english}
\begin{longtable}[]{@{}llll@{}}
\toprule
\begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{Variable}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{RAP[?]10 mmHg} \textbf{(n:57)}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{RAP\textless{}10 mmHg} \textbf{(n:79)}\strut
\end{minipage} & \begin{minipage}[b]{0.24\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{IVCDmax(mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
21,61\selectlanguage{ngerman}±5,45\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
16,26\selectlanguage{ngerman}±2,96\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{IVCDmin(mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
14,97\selectlanguage{ngerman}±6,4\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
8,37\selectlanguage{ngerman}±,61\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{IVCDmax/BSA(mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
11,64\selectlanguage{ngerman}±2,9\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
9,16\selectlanguage{ngerman}±2,06\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{IVCDmin/BSA(mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
8,04\selectlanguage{ngerman}±3,3\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
4,73\selectlanguage{ngerman}±1,71\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{IVCCI(\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
33,12\selectlanguage{ngerman}±14,63\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
49,11\selectlanguage{ngerman}±8,64\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CSDmax(mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
12,4\selectlanguage{ngerman}±2,37\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
10,78\selectlanguage{ngerman}±2,34\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CSDmin(mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
8,54\selectlanguage{ngerman}±2,42\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
5,76\selectlanguage{ngerman}±1,54\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{CSDmax/BSA(mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6,68\selectlanguage{ngerman}±1,22\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
6,06\selectlanguage{ngerman}±1,48\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{CSDmin/BSA(mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
4,59\selectlanguage{ngerman}±1,22\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
3,24\selectlanguage{ngerman}±0,94\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{CSCI(\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
31,85\selectlanguage{ngerman}±9,9\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
46,87\selectlanguage{ngerman}±6,73\strut
\end{minipage} & \begin{minipage}[t]{0.22\columnwidth}\raggedright\strut
\textbf{p\textless{}0,001}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

BSA donates body surface area, CS:coronary sinus, CSD:coronary sinus
diameter, CSCI:coronary sinus collapsibility index, IVC:inferior vena
cava, IVCCI:inferior vena cava collapsibility index, IVCD:inferior vena
cava diameter, RAP:right atrial pressure.

\textbf{Table-3:} Receiver-Operating Characteristic Curve analysis of
IVC and CS parameters predicting RAP [?]10 mmHg\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Varible}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{AUC}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{P value}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Cut-off}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Sensitivity} \textbf{(\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Specificity} \textbf{(\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{PPV} \textbf{(\%)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{NPV} \textbf{(\%)}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{IVCCI (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,804\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
46,1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
75,4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
79,7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
72,9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
81,8\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{CSCI (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,886\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
39,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
75,4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
88,6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
82,7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
83,3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{IVCDmax (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,819\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
19,6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
63,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
87,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
78,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
76,7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{CSDmax (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,681\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
64,9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
77,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
67,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
75,3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{IVCDmin (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,839\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
73,7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
82,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
75\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
81,2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textbf{CSDmin (mm)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,843\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6,1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
84,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
77,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
72,7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
87,1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{IVCDmax/BSA (mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,767\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10,6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
64,9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
81\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
71,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
76,2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{CSDmax/BSA (mm/ m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,681\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5,8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
77,1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
58,2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
57,1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
78\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{IVCDmin/BSA (mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,818\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5,8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
68,4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
87,3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
79,6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
79,3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\selectlanguage{ngerman}\textbf{CSDmin/BSA (mm/m²)}\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
0,819\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
\textless{}0,0001\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3,6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
78,9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
79,7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
73,8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
84\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

AUC donates area under the curve, BSA:body surface area, CS:coronary
sinus, CSD:coronary sinus diameter, CSCI:CS collapsibility index,
IVC:inferior vena cava, IVCCI:inferior vena cava collapsibility index,
IVCD:inferior vena cava diameter, NPV:negative predictive value,
PPV:positive predictive value, RAP:right atrial pressure.

\textbf{Figure-1:} Echocardiographic view of the Coronary Sinus and
measurement of diameters with M-mode

\textbf{Footnote:} CS donates coronary sin\selectlanguage{ngerman}üs, LV left ventricle, RV
right ventricle\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure-2:} Comparison of IVC and CS parameters

\textbf{Footnote:} BSA donates body surface area, CSCI: coronary sinus
collapsibility index, CSD: coronary sinus diameter, IVCCI: inferior vena
cava collapsibility index, IVCD: inferior vena cava diameter

\textbf{Hosted file}

\verb`image2.emf`  available at \url{https://authorea.com/users/435988/articles/538638-using-coronary-sinus-diameter-and-collapse-index-to-estimate-right-atrial-pressure-for-echocardiographic-systolic-pulmonary-arterial-pressure-measurement}

\textbf{Figure-3:} Comparison of coronary sinus parameters and right
artial pressure

\textbf{Footnote:} BSA donates body surface area, CSCI: coronary sinus
collapsibility index, CSD: coronary sinus diameter, RAP: right atrial
pressure

\textbf{Hosted file}

\verb`image3.emf`  available at \url{https://authorea.com/users/435988/articles/538638-using-coronary-sinus-diameter-and-collapse-index-to-estimate-right-atrial-pressure-for-echocardiographic-systolic-pulmonary-arterial-pressure-measurement}

\textbf{Figure-4:} Comparison of inferior vena cava parameters and right
atrial pressure

\textbf{Footnote:} BSA donates body surface area, IVCCI: inferior vena
cava collapsibility index, IVCD: inferior vena cava diameter, RAP: right
atrial pressure

\textbf{Hosted file}

\verb`image4.emf`  available at \url{https://authorea.com/users/435988/articles/538638-using-coronary-sinus-diameter-and-collapse-index-to-estimate-right-atrial-pressure-for-echocardiographic-systolic-pulmonary-arterial-pressure-measurement}

\selectlanguage{english}
\FloatBarrier
\end{document}

