Impact of preload and afterload on global and regional right ventricular function and pressure: a quantitative...

Several quantitative echocardiographic measures of global and regional right ventricular (RV) function have been proposed, but knowledge of the impact of increases in preload and afterload is limited.

Seventeen healthy participants were exposed to increased preload by rapid infusion of 30 mL/kg of saline over 15 minutes, and to increased afterload simulated in an 16- to 18-hour stay in a controlled hypoxic environment (fractional concentration of oxygen in inspired gas = 12.3%). Two-dimensional, Doppler, and Doppler tissue echocardiography evaluations were performed to evaluate global and regional RV function, with changes evaluated by paired analysis.

Peak tricuspid regurgitation velocity increased in both conditions, whereas the RV end-diastolic diameter and acceleration time of the pulmonary forward flow only increased with increased preload and afterload, respectively. Estimates of RV function and contractility remained stable: no changes in the RV isovolumic acceleration (1.6 +/- 0.6 vs 1.6 +/- 0.4 and 1.3 +/- 0.4 cm/s2) or tricuspid annular plane systolic excursion (2.5 +/- 0.4 vs 2.5 +/- 0.3 and 2.6 +/- 0.3 cm) were seen (baseline compared with increased afterload and preload, respectively). The RV index of myocardial performance was increased with increased afterload (0.26 +/- 0.08 vs 0.34 +/- 0.13, P < .05), whereas no changes with increased preload were seen. Changes in loading conditions did not affect the regional strain.

Moderate volume and pressure loading of the RV induces detectable changes in the RV pressure and morphology. Modern echocardiographic measures of systolic RV function seem stable with moderate increases in preload and afterload.