Right and left ventricular performance in acute hypoxemic respiratory failure

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Abstract
We examined biventricular performance on two occasions in 28 patients with acute hypoxemic respiratory failure (ARF), using a combination of invasively determined pressures and flows as well as radionuclide scin-tigraphy to measure the right and left ventricular ejection fractions (RVEF and LVEF, respectively). From the FF and concurrently measured thermodilution stroke volumes, we calculated right and left ventricular end-diastolic and end-systolic volume indices (FDVI and ESVI, respectively). Regression analysis demonstrated that changes (Δ) in global right ventricular function (RVEF) were inversely correlated with concurrent changes in the mean pulmonary arterial pressure (MPAP): Δ RVEF = 0.015 – 0.015 Δ MPAP (r2 = 0.60; p <.005), while an increase in right ventricular preload (RVEDVI) was positively correlated with changes in MPAP: Δ RVEDVI = 2.68 ± 6.27 Δ MPAP (r2 = 0.46; p <.005). Global left ventricular function (LVEF) was related to changes in systemic pressures as well as to right-sided events: Δ LVEF = −0.01 −0.0015(Δ RVESVI) + 0.001(Δ BP systolic) −0.42(CVP/RVEDVI) (r2 = 0.35; p <.01). These data confirm the significant influence of right ventricular afterload on RVEF in ARF patients and an apparent interrelationship between altered right ventricular systolic function and global left ventricular performance.

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