Noninvasive Assessment of Left Ventricle Filling Pattern in Patient with Severe Tricuspid Regurgitation, Pulmonary Regurgitation, Atrial Septal Defect, and Pulmonary Embolism.

Background: Severe tricuspid regurgitation (TR), pulmonic regurgitation (PR), large atrial septal defect (ASD), and large pulmonary embolism (PE) will lead to decreased left ventricular preload, and therefore, might alter left ventricle (LV) filling diastolic parameters. Significant LV preload reduction might preclude LV diastolic function assessment indeterminate.

Methods: This is a controlled study where patients with severe TR, PR, ASD, PE, and without significant LV disease were included in the study group. Stroke volume (SV), E-wave velocity, A-wave velocity, E/A, septal e', lateral e', average E/e', deceleration time, and isovolumic relaxation time (IVRT) were captured from the study group and the control group. The difference of mean of the diastolic parameters in both groups was evaluated as well as the correlation between the SV and the diastolic parameters of the pooled data from both groups.

Results: E wave velocity, E/A ratio, IVRT, deceleration time, septal and lateral e', and SV were significantly lower in the study group while E/e' was significantly higher in the study group. IVRT showed a strong positive correlation with SV. Lateral and septal e' showed a moderate positive correlation to SV while the average E/e' showed inverse correlation to SV.

Conclusion: Standard diastolic parameters should be interpreted with caution in assessing diastolic function in patients with severely decreased preload. However, a significant preload reduction might preclude diastolic function assessment indeterminate.