Relationship Between Hemodynamics and Right Ventricular Function in Patients With Cardiomyopathy: Important Role of Tricuspid Regurgitation

Abstract

Right ventricular (RV) ejection fraction is load sensitive, varying inversely with pulmonary artery pressure. We tested whether this relationship exists in dilated cardiomyopathy. Retrospective chart review. Tertiary care referral medical center. In 25 patients with cardiomyopathy referred for heart transplant evaluation (left ventricular ejection fraction 27 +/- 12%), hemodynamics, radionuclide angiograms, and Doppler echocardiograms were obtained initially (study A) and 8 +/- 8 months later (study B). Right ventricular ejection fraction was 40 +/- 17% on study A and 41 +/- 16% on study B, with a wide range of change between studies (+38 to -28%). Pulmonary artery systolic pressure (PASP) and right atrial pressure increased (52 +/- 9 to 61 +/- 10 mm Hg and 10 +/- 4 to 14 +/- 4 mm Hg, respectively, p < 0.05). There was no relation between PASP and RV ejection fraction (n = 50, r = -0.02, p = 0.87). Also, there was no relation between changes in PASP and RV ejection fraction (n = 25, r = 0.25, p = 0.15) between study A and B. However, there was a significant relation between interstudy changes in PASP and RV ejection fraction (n = 14, r = -0.71, p = 0.005) and end-systolic volume (n = 14, r = 0.53, p < 0.05) in patients in whom the degree of tricuspid regurgitation was either none or mild on both study A and B. In patients with cardiomyopathy, RV ejection fraction cannot be used as a noninvasive marker of pulmonary hypertension. Owing to variation in tricuspid regurgitation, alterations in pulmonary artery pressure over time may not lead to the expected change in RV ejection fraction or end-systolic volume.