BACKGROUND A significant number of patients with acute Inferior wall infarction will have RV dysfunction and most of them have occlusion of either right or left circumflex coronary artery. But RV assessment is not done routinely in echocardiographic examination. Patients present with inferior wall myocardial infarction (IWMI) subsequently develop right ventricular myocardial infarction (RVMI) and have poor prognosis. In this study we wanted to evaluate the incidence of RVMI and the role of echocardiography in assessing RV function and its impact in predicting infarct related artery by angiographic analysis in acute IWMI after thrombolysis. METHODS 86 patients with acute IWMI after thrombolysis were randomly selected. Echocardiographic examination of RV function was performed within 72 hours after thrombolysis. We applied RV echo parameters like FAC (Fractional Area Change %), TAPSE (Tricuspid Annular Plane Systolic Excursion), RV S’ (RV Systolic Excursion Velocity) and MPI (Myocardial Performance Index) to assess RV function. 48 patients underwent coronary angiogram which included 10 patients with normal RV function, rest with RV dysfunction. RESULTS Among 86 patients, we compared 64 patients of RV dysfunction with 22 patients having normal function. Echo indices were significantly lower in RV dysfunction group. FAC ( 27 ± 5.95 vs 45 ± 5.4 ) TAPSE (8.5 ± 2.0 19.59 ± 2.8 ), RV S’ ( 5.78 ± 1.26 vs 17.2 ± 3.5 ) and RVMPI (0.22 ± 0.03 vs 0.57± 0.03). Angiographic analysis of 28 of 38 patients with RV dysfunction showed significant proximal lesion in RCA as compared to only 2 among 10 patients with normal RV function. CONCLUSIONS Conventional echo examination will underestimate RV dysfunction hence we applied echo parameters like FAC, TAPSE, RV S’ and RVMPI and a significant proportion of thrombolysed acute IWMI patients were found to have RV dysfunction and it was also helpful in the prediction of infarct related artery which would be predominantly a critical proximal RCA occlusion. KEY WORDS RVMI (Right Ventricular Myocardial Infarction), FAC (Fractional Area Change %), TAPSE (Tricuspid Annular Plane Systolic Excursion), RV S’ (RV Systolic Excursion Velocity) ,MPI (Myocardial Performance Index), IRA ( Infarct Related Artery)
Tissue Doppler systolic annular velocity and myocardial performance index as predictors of right ventricular affection and culprit lesion location in acute inferior myocardial infarction
