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(Circulation. 2000;101:e117.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Doppler Echocardiographic Index of Global Right Ventricular Function

Malcolm I. Burgess, MRCP; Simon Ray, FRCP, MD, FACC

Northwest Regional Cardiac Centre, Wythenshawe Hospital, Manchester, United Kingdom

Nesrin Mogulkoc, MD; Jim Egan, MRCP, MD

Northwest Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom

	Introduction

 
To the Editor:

In pulmonary disease, right ventricular dysfunction has an important bearing on prognosis.¹ Incalzi et al² recently demonstrated the prognostic implications of electrocardiographic signs of chronic cor pulmonale in patients with chronic obstructive pulmonary disease. Two electrocardiographic features in particular, an S₁S₂S₃ pattern and a P-wave axis of >90°, suggesting right atrial overload, predicted mortality over 13 years of follow-up. This well-conducted study illustrates the importance of an inexpensive diagnostic technique in risk stratification and is of particular value since the clinical signs of cor pulmonale are too insensitive for routine clinical application. It has been preceded by a wealth of work highlighting the considerable effort that has gone into the identification of a prognostic marker that is widely applicable, noninvasive, and easily interpretable and repeatable.

Of note, the authors indicate the failings of echocardiographic evaluation of the right heart in this setting. They refer to the technical difficulties of transthoracic studies in patients with lung hyperinflation and to the high error when pulmonary artery pressure is estimated based on a tricuspid regurgitant jet, which is present in only a minority of patients. Tei et al³ recently described a Doppler echocardiographic index of global right ventricular function based on tricuspid and pulmonary flow dynamics. Assessment of right ventricular function has been confounded by the asymmetrical geometry of the chamber, but since this index is derived from pulsed-wave Doppler measurements, evaluation can be made independently of 2-D imaging, a further advantage given poor patient echogenicity. The index . . . [Full Text of this Article]

Raffaele Antonelli Incalzi, MD; Leonello Fuso, MD; Marino De Rosa, MD; Anteo Di Napoli, MD; Salvatore Basso, MD; Gabriella Pagliari, MD; Riccardo Pistelli, MD

Respiratory Physiology Department, Catholic University, Rome, Italy