Two-Dimensional Echocardiographic Assessment of Right Cardiac Pressure Overload in Patients with Chronic Obstructive Airway Disease

Abstract

Two-dimensional echocardiography was used to estimate right cardiac pressure overload in patients with chronic obstructive airway disease. Area measurements of the four heart chambers were carried out from the apical four-chamber view. Additionally, the respiratory behaviour of the inferior vena cava was examined from the subcostal view. A good apical imaging of the four-chamber view for area measurement was obtained in 44 out of 48 patients with chronic obstructive airway disease. The respiratory behaviour of the inferior vena cava was investigated from the subcostal view in 38 patients. Within 8 days after echocardiography, right cardiac catheterization was carried out in order to measure pulmonary artery and right atrial mean pressures and to determine pulmonary vascular resistance. A good correlation was found between pulmonary artery mean pressure and the following echocardiographic parameters: area index (area/body surface) of the two right heart cavities (r = 0.83), right-to-left ventricular area ratio (r = 0.82) and right-to-left cardiac area ratio (ratio between the added areas of both right heart cavities on the one side and the added areas of both left heart cavities on the other; r = 0.82). Correlation between these parameters and pulmonary vascular resistance (r = 0.71, 0.66 and 0.71, respectively) and between the right atrial mean pressure and the right atrial area index was less close (r = 0.64). On the other hand, the respiratory behaviour of the inferior vena cava proved to be highly specific but not very sensitive in predicting a pathological right atrial pressure. The combination of area measurements with investigation of the respiratory behaviour of the inferior vena cava is a useful method for evaluating the long-term effect of right cardiac pressure overload in patients with chronic obstructive airway disease, who can otherwise only be investigated with difficulty.

Association of Coronary Sinus Diameter with Pulmonary Hypertension

“…Therefore, assessment of additional criteria like right heart chamber volumes and CS diameter may be useful for the prediction of RAP. Machraouni et al 13 found a good correlation between pulmonary artery mean pressure and the area index of the two right heart cavities (r = 0.83) and between RAP and RA area index (r = 0.64). In the study of Raymond et al, 16 RA area index was also closely correlated with RAP (r = 0.72, P < 0.001).…”

“…Use of the size and inspiratory collapsibility of the VCI is the most widely adopted method for the estimation of RAP 9 . Although, a number of studies report a high correlation (0.57–0.93) between TTE and right heart catheterization measurements of PASP, 1 discrepancies have been observed between RAP estimated by the pattern of VCI collapse and measured by right heart catheterization 6,7,13,14 . Vena cava measurements depend on the image being obtained perpendicular to the vessel, and in addition, there may be differences in the collapsibility of the VCI based on variations in inspiratory effort.…”

Coronary sinus dilatation is a sign of impaired right ventricular function in patients with heart failure

“…In addition, a dilated right atrium is a sign of increased RA pressure. Machraouni et al (15) reported a strong correlation between RA pressure and the RA area index (r=0.64). However, this is a qualitative measure that does not allow the interpreter to assess RA pressure (6).…”