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European Heart Journal 1982 3(3):230-237;
Copyright © 1982 by the European Society of Cardiology.
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© 1982 by The European Society of Cardiology

Diagnosis of ischemic right ventricular dysfunction by M-mode echocardiography

J. LOPEZ-SENDON, I. COMA-CANELLA, F. LOMBERA and . BENITO-BARTOLOME

Coronary Care Unit, Servicio de Coronariopatias, Ciudad Sanitaria La Paz, Universidad Autonoma de Madrid, Spain

Received 6 July 1981; revised 26 August 1981; .

Requests for reprints to: J. Lopez-Sendon, M.D., Unidad Coronaria, Ciudad Sanitaria La Paz, Madrid 34, Spain.

Abstract

The importance of right ventricular infarction depends upon the presence and severity of the resultant ischemic right ventricular dysfunction. The usefulness of M-mode echocardiography for the diagnosis of ischemic right ventricular dysfunction was investigated in 63 patients with acute myocardial infarction. Group A included 35 patients with ischemic right ventricular dysfunction, and Group B 28 patients without ischemic right ventricular dysfunction. The diagnosis of ischemic right ventricular dysfunction was made when the right atrial pressure was higher than 10 mm Hg and greater than, equal to or not more than 5 mm Hg less than pulmonary capillary pressure.

Right ventricular diastolic dimension was greater in Group A than in Group B (P<0.01). The upper 95% confidence limit of this parameter was found to be 18 mm/m2 in Group B. The right ventricular/left ventricular diastolic dimension ratio was greater in Group A than in Group B (P <0.01). The upper limit of this ratio in Group B was 0.63.

When either of these two criteria was present (right ventricular diastolic dimension ≥ 18 mm/m2 or right ventricular/left ventricular diastolic dimension≥0.63), the diagnosis of ischemic right ventricular dysfunction could be made in 19 of 35 patients (sensitivity 54.2%), with no false positives (specificity 100%).

The interventricular septum was rapidly displaced upwards at the beginning of systole and downwards during diastole in eight patients from Group A, and in no patient from Group B.

M-mode echocardiographic indices of right ventricular dilatation may be of value in the diagnosis of ischemic right ventricular dysfunction, but their sensitivity is low. The discrepancy between hemodynamic and M-mode echocardiographic parameters of ischemic right ventricular dysfunction may be attributed to impairment of right ventricular compliance, with a right ventricular diastole dimension/right atrial pressure ratio greater in Group B than in Group A (P< 0.01).

Key Words: Right ventricular dysfunction • M-mode echocardiography • right ventricular infarction


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