RELATIONS BETWEEN DOPPLER TRACINGS OF PULMONARY REGURGITATION AND INVASIVE HEMODYNAMICS IN ACUTE RIGHT-VENTRICULAR INFARCTION COMPLICATING INFERIOR WALL LEFT-VENTRICULAR INFARCTION

To test the hypothesis that flow characteristics from pulmonary regurg itation (PR) can predict right ventricular (RV) involvement in patient s with inferior wall acute myocardial infarction, we prospectively rec orded continuous-wave Doppler tracings and right-sided cardiac hemodyn amics in 48 consecutive patients with inferior wall acute myocardial i nfarction and PR. Right heart hemodynamics enabled the identification of 29 patients with (group 1) and 19 without (group 2) RV involvement. In patients with RV involvement, the pulmonary regurgitant flow patte rn was characterized by a rapid rise in flow velocity to a peak level followed by an abrupt deceleration in mid-diastole, whereas in patient s without RV involvement, the deceleration in mid-diastole was gradual . The pressure half-time of PR (PHTPR and the lowest mid-diastolic to peak early diastolic velocity ratio were significantly lower in group 1 than in group 2 (91 +/- 31 vs 214 1 57 ms [p <0.001], 0.35 +/- 0.08 vs 0.59 +/- 0.13 [p <0.001], respectively). The best diagnostic accura cy (95%) was obtained with cut-off values of PHTPR less than or equal to 150 ms and the lowest mid-diastolic to peak early diastolic velocit y ratio less than or equal to 0.5: sensitivity 100% specificity 89%, p ositive predictive value 94%, and negative predictive value 100%. Usin g multiple logistic regression analysis, we found that PHTPR was the s trongest predictor of RV involvement. Thus, these parameters, derived from pulmonary regurgitant tracings, are useful in the noninvasive bes ide diagnosis of RV infarction.