Echocardiographic assessment of right ventricular function in inferior wall myocardial infarction and angiographic correlation to proximal right coronary artery stenosis.
BACKGROUND
Presence of right ventricular (RV) infarction imposes a higher risk of adverse events in inferior wall myocardial infarction (IWMI). In this study, we attempted to correlate various indices of RV function assessed by echocardiography with presence of a proximal right coronary artery (RCA) stenosis in patients with first episode of acute IWMI.


METHODS
In a prospective study, patients with first episode of acute IWMI underwent echocardiographic assessment within 24 h of symptom onset and indices of RV function viz. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients who underwent coronary angiogram (CAG) within one month and they were classified into group 1 and group 2 based on the presence or absence, respectively, of a significant proximal RCA stenosis.


RESULTS
There were 90 patients with first episode of IWMI of which 67 patients underwent CAG. There was significant difference between group 1 (n = 26) and group 2 (n = 41) in TAPSE (13.5 ± 1.3 vs 21.3 ± 1.7, p < 0.001), MPI by tissue Doppler (0.87 ± 0.1 vs 0.55 ± 0.2, p < 0.001) and in tissue Doppler systolic velocity from RV free wall (S' 9.8 ± 1.1 vs 15.0 ± 1.5, p < 0.001). There was a good interobserver correlation for TAPSE, MPI by TDI, and S' velocity. TAPSE ≤ 16 (sensitivity 93%, specificity 100%), MPI-TDI ≥ 0.69 (sensitivity 94.7%, specificity 93.5%), S ≤ 12.3 (sensitivity 90.3%, specificity 94.3%) were useful in predicting presence of proximal RCA stenosis.


CONCLUSION
RV function indices like TAPSE, MPI-TDI and S' velocity are useful in predicting proximal RCA stenosis in first episode of acute IWMI.
['Rajesh|Gopalan Nair|GN|', 'Raju|Deepak|D|', 'Nandan|Deepak|D|', 'Haridasan|Vellani|V|', 'Vinayakumar|Desabandhu|D|', 'Muneer|Kader|K|', 'Sajeev|C G|CG|', 'Babu|Kadangot|K|', 'Krishnan|M N|MN|']
D000368:Aged D015331:Cohort Studies D017023:Coronary Angiography D023921:Coronary Stenosis D018619:Echocardiography, Doppler, Pulsed D005260:Female D006801:Humans D056989:Inferior Wall Myocardial Infarction D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D018570:Risk Assessment D012680:Sensitivity and Specificity D015996:Survival Rate D018497:Ventricular Dysfunction, Right D016278:Ventricular Function, Right
Right ventricular function inferior wall myocardial infarction Right coronary artery stenosis right coronary artery RV IWMI RCA RVFAC tricuspid annular plane systolic excursion TAPSE myocardial performance index MPI coronary angiogram CAG tissue Doppler systolic velocity S' MPI-TDI A' Am BMI E' ET Em HTN ICT IRT LV ejection fraction LVEF MPI-PW PCI RV WMA Right ventricular infarction body mass index ejection time hypertension isovolumic contraction time isovolumic relaxation time mitral early diastolic velocity mitral late diastolic velocity myocardial performance index by pulsed wave Doppler myocardial performance index by tissue Doppler percutaneous coronary intervention right ventricle right ventricular fractional area change right ventricular wall motion abnormalities tissue Doppler early diastolic velocity tissue Doppler late diastolic velocity