Effect of tricuspid regurgitation on diastolic filling of the pressure overloaded right ventricle

ABSTRACT

Diastolic filling of right ventricle [RV] was assessed in 46 patients with pulmonary hypertension [PH] and in 15 controls by pulsed Doppler echo technique. According to different cardiopulmonary diseases, our patients were divided into Gr. I [patients with right ventricular hypertrophy [RVH], and Gr. II [patients with RVH and associated tricuspid regurgitation; TR]. A Doppler was utilized to measure: peak E and A velocities, E/A ratio rapid and atrial filling fractions [RFF, AFF]. Patients of group I had significantly reduced peak E and increased peak A as compared with controls [60 +/- 14 Vs 70 +/- 15 cm/sec., and 78 +/- 16 Vs 50 +/- 12 cm/sec, respectively]. There was also increase in AFF, and reduction in RFF as compared with controls [0.45 +/- 0.09 Vs 0.30 +/- 0.05 and 0.55 +/- 0.10 Vs 0.60 +/- 0.10 respectively]. On the other hand, E/A ratio was reduced significantly in Gr. I as compared to Gr. II and controls [0.9 +/- 0.2 Vs 1.3 +/- 0.4 Gp. II and 1.5 +/- 0.2 controls]. Patients in Gr. II had significantly increased peak E as compared with patients in Gr. I, p < 0.01. The peak A was not significantly changed between both groups [79 +/- 22 Vs 78 +/- 16 in Gr. I]. We conclude that pulsed Doppler echo is a clinically useful, noninvasive method in detecting a disturbance of diastolic filling of [RV], which may be one of the earliest manifestation of mechanical abnormality of the diseased [RV] in patients with RVH. Caution should be taken in patients with associated [TR] as it may augment early diastolic filling and may tend to normalize diastolic filling patterns in patients with RVH