Exploring Noninvasive Tricuspid dP/dt as a Marker of Right Ventricular Function

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Imaging

Background:

• Right ventricular (RV) function is prognostically significant but difficult to assess volumetrically with 2D echocardiography.
• Intra-ventricular pressure rate of rise (dP/dt) reflects myocardial contractility.
• Adjusting dP/dt for maximal regurgitant velocity (Vmax) accounts for preload variations.

Purpose of the Study:

• To evaluate the noninvasive estimation of RV function using tricuspid dP/dt and dP/dt/Vmax.
• To correlate these echocardiographic parameters with RV ejection fraction (RVEF) determined by cardiac magnetic resonance imaging (CMR).

Main Methods:

• Fifty paired CMR and echocardiogram studies within 30 days were analyzed.
• Tricuspid regurgitation (TR) spectral Doppler was used to calculate dP/dt and dP/dt/Vmax.
• RVEF was calculated from CMR images; RVEF >42% defined normal function.

Main Results:

• Tricuspid dP/dt correlated with CMR RVEF (r² = 0.51, P < 0.01).
• The correlation improved when using dP/dt/Vmax (r² = 0.59, P < 0.01).
• A dP/dt >400 mmHg/sec showed 91% positive predictive value for normal RVEF, with 74% sensitivity and 84% specificity.

Conclusions:

• Noninvasive tricuspid dP/dt is a reliable correlate of CMR-derived RVEF.
• A dP/dt threshold of >400 mmHg/sec effectively predicts normal RV function.
• Incorporating Vmax to adjust for preload enhances the correlation between dP/dt and RVEF.