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LETTER TO THE EDITOR

Right ventricular volume determination: not a matter for echocardiography

The echocardiographic methods used in the paper deserve, in our opinion, a few comments. As known, right ventricular anatomy is far more complex than left ventricular anatomy. While left ventricular volumes may be easily and accurately estimated by a number of mathematical formulas (ranging from the m-Mode-derived Teichholz's to the two-dimensional area-length and Simpson's methods; Refs. 1, 4, 5), right ventricle has a complex three-dimensional shape that substantially prevents a feasible echocardiographic way to derive its volume. Even if some ultrasonographic three-dimensional methods seem to be promising (2), first-pass radionuclide angiography still represents the gold standard for a quantitative approach to right ventricular anatomy, and a simply qualitative (or at most semiquantitative) approach seems to be advisable for echocardiography (6).

In their paper, despite windowing limitation imposed by high lung volumes (only subcostal view was accessible), Potkin and coworkers calculated the volumes of both ventricles by Simpson's rule, obtaining quite puzzling results. In fact, simply considering the evaluation at rest, mean values of diastolic and systolic right ventricular volumes are surprisingly low (20 and 5.2 cm³, respectively). Moreover, the estimate of stroke volumes and cardiac output of both ventricles (obtained by mean values of heart rate and ventricular volumes reported in Table 3) shows a huge imbalance between the ventricles, with right ventricular stroke volume and cardiac output less than a quarter of the left ventricular ones.

Even if the aforementioned methodological limitations greatly reduce the strength of results, the paper presents, in our opinion, the interesting hypothesis that lung packing may induce a biventricular systolic dysfunction mediated by an acute right ventricular pressure overload. This hypothesis should be confirmed, by means of more reliable techniques, for a better understanding of hemodynamic consequences of glossopharyngeal insufflation, a widely diffused breathing technique among elite breath-hold divers the health risks of which are not yet clearly defined.

FOOTNOTES

Address for reprint requests and other correspondence: C. Marabotti, U. O. Cardiovascolare-Utic Ospedale di Cecina, Via Montanara, Cecina, Italy 57023 (e-mail: maralbian{at}alice.it)

REFERENCES

1. Folland ED, Parisi AF, Moynihan PF, Ray Jones D, Feldman CL, Tow DE. Assessment of left ventricular ejection fraction and volumes by real-time, two-dimensional echocardiography. A comparison of cineangiographic and radionuclide techniques. Circulation 60: 760–766, 1979.[Abstract/Free Full Text]
2. Pasipoularides AD, Shu M, Womack MS, Shah A, von Ramm O, Glower DD. RV functional imaging: 3-D echo-derived dynamic geometry and flow field simulations. Am J Physiol Heart Circ Physiol 284: H56–H65, 2003.[Abstract/Free Full Text]
3. Potkin R, Cheng V, Siegel R. Effects of glossopharyngeal insufflation on cardiac function: an echocardiographic study in elite breath-hold divers. J Appl Physiol 103: 823–827, 2007.[Abstract/Free Full Text]
4. Schiller NB, Acquat H, Ports TA, Drew D, Goerke J, Ringertz H, Silverman NH, Brundage B, Botvinck EH, Boswell R, Carlsson E, Parmley WW. Left ventricular volume from paired biplane two-dimensional echocardiography. Circulation 60: 547–555, 1979.[Abstract/Free Full Text]
5. Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol 37: 7–11, 1976.[CrossRef][Web of Science][Medline]
6. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 166: 1310–1319, 2002.[Free Full Text]

This article has been cited by other articles:

				R. Potkin, R. Siegel, and V. Cheng Reply from Potkin, Siegel, and Chen J Appl Physiol, May 1, 2008; 104(5): 1548 - 1548. [Full Text] [PDF]

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