Doppler assessment of right ventricular filling dynamics during volume loading in ischemic heart disease

To assess the effects of volume loading on right ventricular (RV) filling dynamics, the RV inflow pattern was recorded using pulsed Doppler echocardiography (PDE) during dextran infusion in 7 normal subjects (Group I) and 24 patients with ischemic heart disease. The patients with ischemic heart disease were divided into three groups according to the left ventricular (LV) and RV ejection fractions (EF). Group II consisted of 11 patients whose LVEF and RVEF exceeded 50%. Group III consisted of 7 patients whose LVEF was lower than 50% and RVEF was higher than 50%. Group IV was comprised of 6 patients whose LVEF and RVEF were lower than 50%. Peak flow velocity of the RV rapid filling wave in early diastole [R(T)] and that of the atrial contraction wave [A(T)] were measured, and the ratio of A(T) to R(T) [A(T)/R(T)] in each cardiac cycle was calculated. In some of the subjects, simultaneous right‐sided cardiac catheterization was performed with a Swan‐Ganz thermodilution catheter. The LV and RV function during volume loading were calculated according to the following formulae: $DL Stroke volume index (SVI)/$DL pulmonary artery wedge pressure (PAWP) and $DLSVI/$DLright atrial pressure (RAP), respectively. After dextran infusion, R(T) increased significantly in Groups I, II, and III, but not in Group IV. The A(T) and A(T)/R(T) ratio remained unchanged in all groups. The percent change of the R(T) correlated well with $DLSVI/$DLRAP (r=0.56, p>0.01). These results suggest that in patients with RV dysfunction, volume loading does not result in an increase in SVI, and this abnormality seems to be related to unchanged R(T) after volume loading because of impairment in RV early diastolic filling. Thus, the assessment of the RV inflow pattern by PDE during dextran infusion was useful in demonstrating RV diastolic dysfunction in IHD.