[Pulsed Doppler echocardiographic evaluation of hemodynamics in premature ventricular contractions]

To investigate hemodynamic changes in ventricular premature contractions (VPCs), the blood flow velocities at the left ventricular (LV) outflow and inflow tracts were analyzed by pulsed Doppler echocardiography in 23 patients with VPCs and in two patients with ventricular parasystoles. Percent LV stroke volume of the ectopic and the postectopic sinus beats to the other sinus beats and %LV inflow volume of the sinus beats preceding ectopic beats to the other sinus beats were calculated from the time integral of the blood flow velocity. The following results were obtained. The %LV stroke volume of VPCs or %LV inflow volume of the preceding sinus beats correlated positively with the coupling interval of VPCs (r = 0.69, p less than 0.001 and r = 0.67, p less than 0.001, respectively). The %LV stroke volume of VPCs correlated positively with %LV inflow volume of the preceding sinus beats (r = 0.84, p less than 0.001). In some patients with VPCs of the RBBB pattern and in one patient with VPCs of the LBBB pattern associated with abnormal right axis deviation, the %LV stroke volume of VPC was much more reduced. In patients with depressed rapid filling and increased atrial filling, %LV stroke volume of the VPC or %LV inflow volume of the preceding sinus beat was smaller than in the other patients with the same coupling interval of VPCs. In VPCs of right ventricular (RV) origin, deterioration of RV hemodynamics was more prominent than in those of LV origin, and vice versa. Increased LV stroke volume was observed in postextrasystolic sinus beats, related to the coupling intervals of VPCs. However, the sum of %LV stroke volume of VPC and the postextrasystolic sinus beat decreased as the coupling intervals of VPC shortened. These results suggest that not only the coupling interval and the origin of VPCs but the LV diastolic behavior, as well, are important factors determining the hemodynamics in VPCs. They also suggest that the increment of stroke volume in postextrasystolic beats is more prominent in VPCs with shorter coupling intervals, but the LV performance as a whole is more depressed in VPCs with a shorter coupling intervals. In conclusion, pulsed Doppler echocardiography proved a useful noninvasive technique for evaluating the hemodynamics of VPCs.