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(Circulation. 2007;116:1015-1023.)
© 2007 American Heart Association, Inc.

Imaging

Noninvasive Assessment of the Right Ventricular Filling Pressure Gradient

Cristina Cortina, MD; Javier Bermejo, MD, PhD; Raquel Yotti, MD, PhD; M. Mar Desco, MD, PhD; Daniel Rodríguez-Pérez, PhD; J. Carlos Antoranz, PhD; José Luis Rojo-Álvarez, MEng, PhD; Damien Garcia, Eng, PhD; Miguel A. García-Fernández, MD, PhD; Francisco Fernández-Avilés, MD, PhD

From the Department of Cardiology (C.C., J.B., D.G., M.A.G.-F., F.F.-A.) and the Unit of Experimental Medicine and Surgery (M.M.D.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Mathematical Physics and Fluids (D.R.-P., J.C.A.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain; and the Department of Signal Theory and Communications (J.L.R.-A.), Universidad Rey Juan Carlos, Madrid, Spain.

Correspondence to Javier Bermejo, MD, PhD, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain. E-mail javbermejo{at}jet.es

Received January 18, 2007; accepted June 26, 2007.

Background— The physiological basis of right ventricular (RV) diastolic function remains incompletely studied in humans. The driving force responsible for RV filling, the pressure gradient along the RV inlet from the right atrium to the RV apex, has never been measured in the clinical setting.

Methods and Results— We validated a method for measuring the RV filling pressure difference (RVFPD) from color Doppler M-mode recordings in 12 pigs undergoing interventions on RV preload, afterload, and lusitropic states (error, –0.1±0.4 mm Hg compared with micromanometers; intraclass correlation coefficient, 0.88). Peak early RVFPD correlated directly with mean right atrial pressure and inversely with the time constant of RV relaxation. In 21 patients with dilated cardiomyopathy, the peak RVFPD was 1.0 mm Hg (95% CI, 0.8 to 1.2), significantly lower than in age-matched control subjects (1.4 mm Hg; 95% CI, 1.2 to 1.6). In another population of 19 young healthy volunteers, the peak RVFPD was 2.3 mm Hg (95% CI, 2.0 to 2.6), which was reduced by nitroglycerine and esmolol and was augmented by volume overload and atropine infusions. RVFPD was generated almost exclusively by inertial forces.

Conclusions— For the first time, the RV driving filling force can be accurately measured noninvasively in the clinical setting, and the method is sensitive to detect the effects of preload, chronotropic, and lusitropic states. In patients with dilated cardiomyopathy, the RV filling force is markedly reduced, indicating severely impaired RV relaxation. These findings suggest that this is a useful tool for improving the clinical assessment of RV diastolic function.

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CLINICAL PERSPECTIVE