Right ventricular involvement and conduction disturbances in acute inferior wall myocardial infarction patients and their angiographic correlation
Keywords:Echocardiography, Inferior wall myocardial infarction, Right ventricular function, Tissue Doppler imaging
Background: Right ventricular myocardial infarction (RVMI) in the setting of inferior wall myocardial infarction (IWMI) is associated with adverse events. The study aimed to evaluate right ventricular (RV) systolic function in the first episode of IWMI by echocardiography; determine incidence of different conduction abnormalities during hospitalization in IWMI patients with and without RVMI; and determine association of these parameters with the location of significant lesion in the infarct related artery.
Methods: This was a prospective study conducted from March 2014 to February 2015. Patients diagnosed with a first episode of acute ST-segment elevation IWMI who presented within 12 hours of symptom onset participated in the study. Patients were divided into two groups according to location of myocardial infarction based on electrocardiographic (ECG) findings. Four echocardiographic parameters of RV systolic function: tricuspid annular plane systolic excursion (TAPSE); systolic excursion velocity of lateral tricuspid annulus (S'); myocardial performance index by pulsed Doppler method (MPI-PD); and right ventricular fraction area change (RV-FAC) were measured.
Results: Clinical presentation such as Kussmaul sign (<0.05), hypotension (<0.05), and raised jugular venous pressure (<0.05) were higher in the IWMI+RVMI group than the IWMI group. ECG-based criteria, ST elevation in V4R to predict RVMI revealed 78.84% sensitivity, 88.86% and 87.46% positive predictive value (p<0.05). TAPSE (13.44±1.46 versus 21.0±1.16 mm, p<0.05), S’ (9.03±1.51 versus 16.26±1.21 cm/sec, p<0.05) and RV-FAC (31.24±3.15 versus 47.17±3.65%, p<0.05) were lower in the IWMI+RVMI group compared to the IWMI group.
Conclusions: Cut-off values of TAPSE, S’, MPI-PD, and RV-FAC have high sensitivity and specificity for predicting proximal right coronary artery lesions.
Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, et al. Right ventricular function and failure: Report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114(17):1883-91.
El Missiri AM, Guindy RR. Echocardiographic assessment of right ventricular functions in patients with proximal right coronary artery chronic total occlusion. Int J Cardiovasc Imag. 2016;32(6):895-903.
Kukla P, Dudek D, Rakowski T, Dziewierz A, Mielecki W, Szczuka K, et al. Inferior wall myocardial infarction with or without right ventricular involvement-treatment and in-hospital course. Kardiol Pol. 2006;64(6):583-7.
Bayata S, Avcı E, Yeşil M, Arıkan E, Postacı N, Tülüce SY. Tricuspid annular motion in right coronary artery-related acute inferior myocardial infarction with or without right ventricular involvement. Anatol J Cardiol. 2011;11(6):504-8.
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713.
Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. Right ventricular function in patients with first inferior myocardial infarction: Assessment by tricuspid annular motion and tricuspid annular velocity. Am Heart J. 2000;139(4):710-5.
Mukhaini M, Prashanth P, Abdulrehman S, Zadjali M. Assessment of right ventricular diastolic function by tissue Doppler imaging in patients with acute right ventricular myocardial infarction. Echocardiography. 2010;27(5):539-43.
Pirzada AM, Zaman KS, Mahmood K, Sagheer T, Mahar SA, Jafri MH. High degree atrioventricular block in patients with acute inferior myocardial infarction with and without right ventricular involvement. J Coll Phys Surg Pak. 2009;19(5):269-74.
Samadikhah J, Hakim SH, Asl AA, Azarfarin R, Ghaffari S, Khalili A. Arrhythmia and conduction disorders in acute inferior myocardial infarction with right ventricular involvement. Rawal Med J. 2007;59(16):135-8.
George S, Patel M, Thakkar A. Clinical profile and in-hospital outcome of patients with right ventricular myocardial infarction. Int J Clin Med. 2014;2014(5):459-63.
Klein H, Tordjman T, Ninio R, Sareli P, Oren V, Lang R, et al. The early recognition of right ventricular infarction: Diagnostic accuracy of the electrocardiographic V4R lead. Circulation. 1983;67(3):558-65.
Rajesh GN, Raju D, Nandan D, Haridasan V, Vinayakumar D, Muneer K, et al. Echocardiographic assessment of right ventricular function in inferior wall myocardial infarction and angiographic correlation to proximal right coronary artery stenosis. Indian Heart J. 2013;65(5):522-8.