Doppler study of hepatic venous flow does it predict right atrial pressuresin right ventricular infarction?

The aim of this study was to test the hypothesis that Doppler study of hepa tic venous flow, reflecting right atrial pressures and right ventricular dy sfunction, allows prediction of increased right atrial pressure and right v entricular dysfunction in patients with right ventricular infarction. The authors studied 30 patients (27 men, mean age 54 +/- 12 years) in sinus rhythm with acute inferior myocardial infarction who underwent right heart catheterisation and Doppler echocardiography including recording of regurg itant and hepatic vein flow within 4B hours of hospital admission. Hepatic venous flow was used to measure peak velocity and velocity time integrals ( VTI) of the systolic (S), diastolic (D) and atrial (a) contraction waves. T he fraction of systolic filling was calculated : VTI S / VTI S+VTI D. The p ressure half-time of pulmonary regurgitant flow (PHT IP) was also measured. Using haemodynamic criteria (non-compliant right atria[ pressure wave form or right ventricular end diastolic pressure / pulmonary capillary pressure greater than or equal to0.8), patients were divided into two groups: Group 1: right ventricular infarction (VD+, N=22), Group 2: no right ventricular infarction (VD-, N=8). No correlation was observed between Doppler parameters of hepatic venous fl ow and haemodynamic data, in particular right atria[ pressure and pressure wave form. Moreover, no statistically significant difference was observed b etween the two groups with respect to the Doppler parameters derived from h epatic venous flow. On the other hand, the results confirmed good diagnosti c performance of Doppler analysis of pulmonary regurgitant flow: sensitivit y 80%, specificity 83%, positive predictive value 94%, negative predictive value 55%. The authors conclude that, in patients with acute inferior wall infarction, Doppler analysis of hepatic venous flow does not allow assessment of right atrial pressure or of ischaemic right ventricular dysfunction.