2-DIMENSIONAL ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT CARDIAC PRESSURE-OVERLOAD IN PATIENTS WITH CHRONIC OBSTRUCTIVE AIRWAY DISEASE

Two-dimensional echocardiography was used to estimate right cardiac pr essure overload in patients with chronic obstructive airway disease. A rea measurements of the four heart chambers were carried out from the apical four-chamber view. Additionally, the respiratory behaviour of t he inferior vena cava was examined from the subcostal view. A good api cal 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 echocardiograp hy, right cardiac catheterization was carried out in order to measure pulmonary artery and right atrial mean pressures and to determine pulm onary vascular resistance. A good correlation was found between pulmon ary artery mean pressure and the following echocardiographic parameter s: 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-l eft cardiac area ratio (ratio between the added areas of both right he art cavities on the one side and the added areas of both left heart ca vities on the other; r = 0.82). Correlation between these parameters a nd pulmonary vascular resistance (r = 0.71, 0.66 and 0.71, respectivel y) and between the right atrial mean pressure and the right atrial are a 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 n ot very sensitive in predicting a pathological right atrial pressure. The combination of area measurements with investigation of the respira tory behaviour of the inferior vena cava is a useful method for evalua ting the long-term effect of right cardiac pressure overload in patien ts with chronic obstructive airway disease, who can otherwise only be investigated with difficulty.