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16th World Cardiology Congress

Dubai, UAE

Hanan Radwan

Zagazig University, Egypt

Title: Right ventricular echocardiographic parameters for prediction of proximal right coronary artery lesion in patients with first acute inferior wall myocardial infarction

Biography

Biography: Hanan Radwan

Abstract

Background : Presence of right ventricular myocardial infarction (RVMI) imposes an increased risk of shock, arrhythmia and death in inferior wall myocardial infarction (IWMI) .There are only limited studies validating usefulness of various echocardiographic  parameters of RV function in assessing RV infarction and prediction of proximal RCA stenosis .

Objective : We  aimed  to assess  the validity of echocardiographic parameters assessing right ventricular (RV) function for  prediction of proximal right coronary artery (RCA)  stenosis in patients with first episode of acute inferior wall myocardial infarction  .

Methods :This is prospective study  included 128  patients with first episode of acute IWMI who present within 24 hour of onset of symptoms.  Patients with previous abnormal left ventricular function; left bundle branch block (LBBB); atrial fibrillation (AF); paced rhythm;  pulmonary hypertension > 40 mmHg ; pulmonary embolism and poor echo window were excluded . All patients were subjected to the following:  ECG, cardiac enzymes (CKMB) and troponin and transthoracic   echocardiography (TTE)  which was done  within 24 hours of symptom onset to assess right ventricular (RV) systolic function using different parameters : RV fractional area change (RV-FAC) , myocardial perfusion index of RV MPI – by Pulsed Wave Doppler & by Tissue Doppler Imaging  which was calculated as (MPI = IVRT + IVCT/ET). , tricuspid  annular plane systolic excursion (TAPSE) and  DTI-Derived Tricuspid  lateral annular systolic velocity ( S wave velocity)   . LV dimension (ESD, EDD ) and ejection fraction  . Coronary angiography performed as apart of primary PCI or within one month as an elective procedure.   Patients were divided into two groups, Group 1:  Patients  with  significant  proximal RCA stenosis ( included 42 patients), Group 2:  Patients without  significant proximal RCA stenosis,( included 86 patients).

Results :Patients with proximal RCA ( group 1 ) had significantly lower blood pressure (p = 0.001)  and heart rate ( p=0.0218) , higher level of troponin  p = 0.009, there were significant difference in TAPSE (12.5 ±2.6  vs  21.1 ± 3.3, p = 0.0001) , RVFAC  ( 23.8 ± 6  vs  41.6 ± 5.2 .p = 0.0001 ), MPI-PW  (0.5 ± 0.07 vs 0.28 ± 0.05 , p = 0.0001); MPI-TDI  (0.603 ±  0.06  vs 0.39 ± 0.04, p = 0.0001), lower S wave velocity (10.44 ± 2.61 cm/s vs. 12.11 ± 2.94 cm/s, p = 0.013)  . A cut-off value of  ≥0.557 for MPI had a sensitivity of 95.2 and specificity of 90.7% for the diagnosis proximal RCA. A cut-off value of  TAPSE ≤  16.5 had a sensitivity of 100% and specificity of 95.3% for the diagnosis proximal RCA and  A cut-off value of  RVFAC ≤ 34  had a sensitivity of 100% and specificity of 95.3% for the diagnosis proximal RCA.

 

Conclusion: RV function parameters  are useful for  prediction of proximal RCA stenosis in patients with acute inferior MI.