Myocardial tissue Doppler-based indexes to distinguish right ventricular volume overload from right ventricular pressure overload.
The objective of this study was to develop tissue Doppler parameters that could be used to differentiate right ventricular (RV) volume overload from RV pressure overload. The RV-pressure-overload group consisted of 40 patients with severe pulmonary hypertension, and the RV-volume-overload group consisted of 40 patients who had an atrial septal defect without evidence of right-to-left shunt, significant pulmonary hypertension, or Eisenmenger's complex. Another 40 healthy subjects were enrolled and served as a control group. Routine echocardiography and tissue Doppler imaging were performed. RV myocardial performance index was determined based on data collected during tissue Doppler imaging over the lateral tricuspid annulus. In patients with RV pressure overload, tissue Doppler parameters showed characteristically lower systolic velocity over the tricuspid annulus (RV myocardial systolic wave [Sm]) and longer isovolumic relaxation time (RV-IVRT). Nevertheless, in patients with RV volume overload, RV-Sm increased significantly, but early-diastolic velocity over tricuspid annulus was relatively low. In conclusion, RV-MPI, RV-Sm/early-diastolic velocity over tricuspid annulus, and RV-IVRT/RV-Sm were all useful to differentiate RV pressure overload from volume overload, although RV-IVRT/RV-Sm was the best parameter, with excellent sensitivity and specificity.
Hsiao
Shih-Hung
SH
Department of Internal Medicine, Cardiovascular Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. a841120@ms3.hinet.net
Wang
Wen-Chin
WC
Yang
Shu-Hsin
SH
Lee
Chiu-Yen
CY
Chang
Shu-Mei
SM
Lin
Shih-Kai
SK
Chiou
Kuan-Rau
KR
D000328:Adult; D002306:Cardiac Volume / Q000502:physiology*; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology; D008297:Male; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017725:Ventricular Pressure / Q000502:physiology*