Noninvasive Estimation of Ventricular Filling Pressures in Patients with Single Right Ventricles

Background: Increased ventricular end-diastolic pressure (VEDP) is a known risk factor for morbidity and mortality in patients with single-ventricle physiology. Spectral Doppler tissue imaging (DTI) has been shown to modestly correlate with direct measurement of VEDP. Strain rate (SR) values, obtained via myocardial deformation, have not yet been compared with VEDP in this patient population. The goal of this study was to evaluate which of these imaging techniques correlates best with VEDP in patients with single-RV (RV) physiology. Methods: Patients with single-RV physiology who underwent simultaneous echocardiography and catheterization were evaluated. Echocardiographic data included global longitudinal SR early diastolic wave (SRe) and SR late diastolic wave (SRa), DTI early diastolic wave (e') and DTI late diastolic wave (a') of the right ventricular free wall, and right atrioventricular valve inflow velocities (E and A waves). E/SRe and E/e' ratios were calculated. VEDP was obtained from the catheterization report. Results: Twenty-seven studies were performed on patients with single-RV physiology. The median age at the time of catheterization was 11.4 months (range, 0-132 months). The mean VEDP was 9.9 +/- 4.5 mm Hg. VEDP correlated significantly with E/SRe ratio (r = 0.88), global SRe (r = -0.52), SRe/SR late diastolic wave ratio (r = -0.42), and valve A velocity (r = 0.48). There were no significant correlations between VEDP and DTI measurements. Receiver operating characteristic curve analysis using an E/SRe cutoff of 150 cm showed 87.5% sensitivity and 78.9% specificity for predicting VEDP > 10 mm Hg. Conclusions: In patients with single-RV physiology, VEDP correlated strongly with SR but not with DTI measurements. SR measurements should be considered as a possible means to estimate VEDP in this complex patient population rather than DTI.