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Respiratory Variation in Mitral Flow Velocity in Pericardial Effusion and Cardiac Tamponade

It has been suggested that the presence of increased respiratory variation in mitral flow velocity (RVIMFV) in patients with pericardial effusion (PE) represents significant hemo dynamic compromise regardless of the amount of PE or 2D-echo findings. Recent exper imental data do not, however, support this aspect. The aim of this study was to evaluate the relation of RVIMFV to clinical, hemody namic, and 2D-echo findings in patients with PE and cardiac tamponade (CT). Therefore, 11 patients with PE and CT were studied with right-heart, pericardial, and arterial pressure measurements in conjunction with 2D and Doppler echocardiography during three stages of gradually decreasing PE, ie, (1) before any PE drainage, (2) after partial PE drainage, and (3) after full drainage. A significant RVIMFV was noted during all three stages of our study It was maximal at the early stage [respiratory difference in mitral flow velocity (ΔMFV): 16.8 ±6.3 cm/sec, 24.1%, P = 0.0000026] coinciding with pulsus paradoxus, high pericardial pressure, and diastolic right heart collapse, and it decreased slightly after partial drainage when all signs of CT receded (ΔMFV:13.7 ±9.7 cm/sec, 18%, P = 0.00043). However, there was still some RVIMFV (ΔMFV:8.7 ±7.6 cm/sec, 13.9%, P = 0.0017) after full peri cardial drainage. It is concluded that the presence and the magnitude of RVIMFV is not predictive of hemodynamic compromise in patients with PE.