Relationship between mean right atrial pressure and Doppler parameters in patients with right ventricular infarction

The incidence of an inferior left ventricular infarction involving the right ventricle is very high, ranging from 14 to 84%. Isolated right ventricular infarction accounts for < 3% of all cases of infarction.

The aim of the present study was to assess the relationship between Doppler parameters of hepatic vein and tricuspid inflow, as well as mean right atrial (RA) pressure in patients with right ventricular infarction.

In all, 59 consecutive patients with inferior left ventricular infarction involving the right ventricle were selected for the study. All patients underwent Doppler echocardiographic evaluation of tricuspid and hepatic vein parameters and catheterization of the right side of the heart. Patients were divided into two groups according to the presence or absence of severe tricuspid regurgitation.

In patients with severe tricuspid regurgitation, a significant correlation (r = 0.64; p < 0.001) between RA maximal volume and mean right atrial pressure (RAP) was found, and the sensitivity of RA maximal volume in identifying mean RAP > 7 mmHg was 64% with a specificity of 78%. In patients without severe tricuspid regurgitation, the most significant relationship was observed between mean RAP and inferior vena cava collapse index. Significant correlations between maximal and minimal diameters of the inferior vena cava were also observed.

Echocardiographic and Doppler parameters may be useful for evaluating mean RAP in patients with right ventricular infarction. In patients with severe tricuspid regurgitation, the more important parameters are maximal and minimal RA volumes. In patients without severe tricuspid regurgitation together with right atrial volume, the important parameters are acceleration and deceleration time of the tricuspid inflow peak E velocity and hepatic systolic and diastolic venous flow.