Abstract
To evaluate the ability of two-dimensional echocardiographic indexes to determine the hemodynamic significance of the right ventricular infarction, 24 patients with electrocardiographic evidence of right ventricular infarction were studied. Hemodynamic significance was defined as a jugular venous pressure > 17 cm H2O or a right atrial pressure > 13 mm Hg. Patients with hemodynamically significant right ventricular infarctions (group I, n = 9) had a 56% incidence of hypotension (blood pressure <90 mm Hg) with a mean systolic blood pressure of 93 ± 23 mm Hg, whereas patients with nonhemodynamically significant right ventricular infarctions (group II, n = 15) had no hypotension and a mean systolic blood pressure of 121 ± 18 mm Hg (p < 0.01). The ratio of right atrial to pulmonary capillary wedge pressure was 1.1 ± 0.6 in group I and 0.6 ± 0.2 in group II (p < 0.05). Echocardiography demonstrated right ventricular free wall motion abnormalities in seven patients in group I and in 10 patients in group II. The descent of the right ventricular base was 0.7 ± 0.2 cm in group I, 1.3 ± 0.4 cm in group II, and 2.0 ± 0.2 cm in a group of 20 normal control patients (p < 0.001 for all comparisons). The respiratory caval index (percentage of collapse of the inferior vena cava with inspiration) was 22% ± 11% in group I, 45% ± 15% in group II, and 64% ± 17% in the control subjects (p < 0.05 for all comparisons). The ratio of right to left ventricular size was 1.1 ± 0.5 in group I, 0.6 ± 0.3 in group II, and 0.5 ± 0.2 in the control subjects (p < 0.005 for group I versus group II and the control subjects). Descent of the right ventricular base and the respiratory caval index were the most sensitive markers for hemodynamically significant right ventricular infarction, whereas the ratio of right to left ventricular size and descent of the base were specific. Two-dimensional echocardiography is helpful in the determination of the hemodynamic significance of right ventricular infarction.