Comparison of tricuspid inflow and superior vena caval Doppler velocities in acute simulated hypovolemia: new non-invasive indices for evaluating right ventricular preload

BackgroundAssessment of cardiac preload is important for clinical management of some emergencies related to hypovolemia. Effects of acute simulated hypovolemia on Doppler blood flow velocity indices of tricuspid valve (TV) and superior vena cava (SVC) were investigated in order to find sensitive Doppler indices for predicting right ventricular preload.MethodsDoppler flow patterns of SVC and TV in 12 healthy young men were examined by transthoracic echocardiography (TTE) during graded lower body negative pressure (LBNP) of up to -60 mm Hg which simulated acute hypovolemia. Peak velocities of all waves and their related ratios (SVC S/D and tricuspid E/A) were measured, calculated and statistically analyzed.ResultsExcept for the velocity of tricuspid A wave, velocities of all waves and their related ratios declined during volume decentralization. Of all indices measured, the peak velocities of S wave and AR wave in SVC correlated most strongly with levels of LBNP (r = -0.744 and -0.771, p < 0.001).ConclusionThe S and AR velocities are of good values in assessing right ventricular preload. Monitoring SVC flow may provide a relatively noninvasive means to assess direct changes in right ventricular preload.

[1]  L. Tavazzi,et al.  Doppler Velocimetry in Superior Vena Cava Provides Useful Information on the Right Circulatory Function in Patients with Congestive Heart Failure , 2001, Echocardiography.

[2]  W. Buhre,et al.  Prediction of fluid responsiveness in patients during cardiac surgery. , 2004, British journal of anaesthesia.

[3]  Antoine Vieillard-Baron,et al.  Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients , 2004, Intensive Care Medicine.

[4]  G. Regolisti,et al.  Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects. , 2004, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[5]  Yong-jie Yao,et al.  Effect of lower body negative pressure on orthostatic tolerance and cardiac function during 21 days head-down tilt bed rest. , 2003, Journal of gravitational physiology : a journal of the International Society for Gravitational Physiology.

[6]  A. Labovitz,et al.  Relation between pulmonary venous flow and pulmonary wedge pressure: influence of cardiac output. , 1995, American heart journal.

[7]  P. Barbier,et al.  Pulmonary venous flow velocity patterns in 143 normal subjects aged 20 to 80 years old. An echo 2D colour Doppler cooperative study. , 1997, European heart journal.

[8]  J. Teboul,et al.  Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation , 2000, Critical care.

[9]  J. Seward,et al.  Comparison of mitral inflow and superior vena cava Doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis. , 1998, Journal of the American College of Cardiology.

[10]  S. Goldstein,et al.  Load dependence of left atrial and left ventricular filling dynamics by transthoracic and transesophageal Doppler echocardiography. , 1996, American journal of cardiac imaging.

[11]  J. Teboul,et al.  Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. , 2001, Chest.

[12]  R. Walsh,et al.  Influence of Loading Conditions and Contractile State on Pulmonary Venous Flow Validation of Doppler Velocimetry , 1992, Circulation.

[13]  Kathy L Ryan,et al.  Lower body negative pressure as a model to study progression to acute hemorrhagic shock in humans. , 2004, Journal of applied physiology.

[14]  James D. Thomas,et al.  Pulmonary venous flow by doppler echocardiography: revisited 12 years later. , 2003, Journal of the American College of Cardiology.

[15]  J. Teboul,et al.  The respiratory variation in inferior vena cava diameter as a guide to fluid therapy , 2004, Intensive Care Medicine.

[16]  Y. Hirota,et al.  Ratio of pulmonary venous to mitral A velocity is a useful marker for predicting mean pulmonary capillary wedge pressure in patients with left ventricular systolic dysfunction. , 1998, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.