NONINVASIVE ESTIMATION OF RIGHT-VENTRICULAR SYSTOLIC PRESSURE IN POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - AN ASSESSMENT OF 2 DOPPLER-ECHOCARDIOGRAPHIC METHODS

Objective: To evaluate the diagnostic accuracy of Doppler echocardiogr aphy in the assessment of right heart hemodynamics and the diagnosis o f pulmonary hypertension in patients with ventricular septal rupture d ue to acute myocardial infarction, Design: A prospective, echocardiogr aphic and right-heart catheterization study, Setting: Medical intensiv e care unit (ICU) of a university hospital. Patients: Twelve consecuti ve patients admitted to the ICU with the diagnosis of ventricular sept al rupture in the setting of acute myocardial infarction. Confirmation of diagnosis was made during surgery (11 patients) or by autopsy (one patient). Interventions: All patients were examined by two-dimensiona l and Doppler echocardiography on admission and subsequently underwent bedside right-heart catheterization. Measurements and Main Results: A fter identification and localization of the rupture site by two-dimens ional echocardiography and/or color flow Doppler mapping, the maximal flow velocity of the transseptal jet was measured by continuous wave D oppler and was used to calculate the peak interventricular pressure gr adient by the modified Bernoulli equation. This value was subtracted f rom the systolic arterial blood pressure value to estimate right ventr icular systolic pressure. The values obtained correlated well with cat heter-derived measurements (r(2) = .71; p = .001). Furthermore, in eig ht (67%) patients, right ventricular systolic pressure could also be d etermined by Doppler interrogation of the tricuspid regurgitant jet. D irect comparison of the results of the two echocardiographic methods y ielded a good correlation (r(2) = .66; p = .016). Conclusion: Doppler examination of the transseptal and tricuspid regurgitant jets is appli cable to patients with ventricular septal rupture for rapid, noninvasi ve prediction of right ventricular hemodynamics.