Right ventricular dp/dt/pmax, not dp/dtmax, noninvasively derived from tricuspid regurgitation velocity is a useful index of right ventricular contractility

Abstract

Background: Although right ventricular (RV) contractility is important in determining functional capacity, few quantification methods are clinically available. RV dP/dtmax can be assessed by Doppler echocardiography by using tricuspid regurgitation (TR) but is not routinely used because of its dependency on a Doppler incident angle and preload. Doppler-derived dP/dt/Pmax is relatively insensitive to preload and theoretically independent of the incident angle. We investigated the clinical feasibility of this index as an RV contractility index. Methods: We computed RV dP/dtmax and dP/dt/Pmax from the TR-derived RV pressure in 68 patients with dominant RV failure (13 in New York Heart Association [NYHA] class I, 33 in class II, 17 in class III, and 5 in class IV). Peak oxygen consumption (peak VO2) was measured in 20 patients during a maximal bicycle ergometer test. Results: dP/dtmax did not significantly correlate with NYHA class. In contrast, dP/dt/Pmax decreased monotonically with the functional class (r = −0.49, P <.0001), and correlated with peak VO2 (r = 0.66, P <.002). Conclusion: TR-derived dP/dt/Pmax, not dP/dtmax, is a clinically useful index of RV contractility, allowing researchers to account for the functional capacity. (J Am Soc Echocardiog 2002;15:136-142.)