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Correlation among right ventricular preload, afterload and ejection fraction in mitral valve disease: radionuclide, echocardiographic and hemodynamic evaluation.

Abstract：

:The relation among right ventricular preload, afterload and ejection fraction in patients with mitral valve disease has not been well elucidated. In this study, measurements were made of intracardiac pressures and forward cardiac output during cardiac catheterization (n = 43), the ejection fraction by radionuclide angiography (n = 43) and end-systolic radius and wall thickness by M-mode echocardiography (n = 22). There was a linear correlation between pulmonary artery pressure and right atrial pressure (r = 0.57, p less than 0.01). The right ventricular peak circumferential systolic wall stress was increased in 68% of the patients (in comparison with wall stress measurements obtained in 10 normal subjects). The right ventricular ejection fraction was abnormal in 38 patients (88%) and abnormal in 14 of the 15 patients with high wall stress. There was an inverse correlation between ejection fraction and end-diastolic volume (r = -0.61, p less than 0.001). The right ventricular ejection fraction measurement was repeated within 3 months after mitral valve replacement in 16 patients; the ejection fraction increased from 21 +/- 9 to 29 +/- 10% (mean +/- standard deviation) after surgery (p less than 0.01), but normalization of the ejection fraction was observed in only 3 patients (19%). Thus, abnormal right ventricular ejection fraction, which is observed in most patients with rheumatic mitral valve disease, results from inappropriate wall stress or depressed inotropic response of the right ventricle due to damage. Right ventricular dilation appears to be a compensatory mechanism to maintain the cardiac output.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Iskandrian AS,Hakki AH,Ren JF,Kotler MN,Mintz GS,Ross J,Kane SA

doi

10.1016/s0735-1097(84)80278-8

subject

Has Abstract

pub_date

1984-06-01 00:00:00

pages

1403-11

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(84)80278-8

journal_volume

pub_type

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Correlation among right ventricular preload, afterload and ejection fraction in mitral valve disease: radionuclide, echocardiographic and hemodynamic evaluation.