No abstract

Right ventricular myocardial infarction (RVMI) damages the systolic and diastolic functions of the RV, so the right atrium interacts with the RV with an acutely altered function. The aim of our study was to compare right atrial function as evaluated by 2D speckle-tracking echocardiography (2DSTE) between patients with inferior wall myocardial infarction (INFMI) and patients affected by both inferior myocardial infarction and right ventricular myocardial infarction (INFMI + RVMI). Our study recruited 70 consecutive patients with INFMI (43 patients without RVMI and 27 patients with RVMI). Right atrial function was evaluated by 2DSTE. Early diastolic strain, systolic strain rate, absolute value of early diastolic strain rate, expansion index, and diastolic emptying index of the right atrium were reduced in the patients with INFMI + RVMI compared to the patients with INFMI. The area under the curve for early diastolic strain for INFMI diagnosis was 0.682 (p value = 0.011, 95 % CI 0.550-0.815). Right atrial early diastolic longitudinal strain <27.5 % had 59.3 % sensitivity and 79.1 % specificity for the discrimination of INFMI + RVMI from INFMI. Our results demonstrated that right atrial reservoir and conduit functions were impaired in the patients with INFMI + RVMI compared with the patients with INFMI.

Aim: Our aim was to determine the clinical, electrocardiographic (ECG) and biochemical predictors of left ventricular dysfunction in patients with acute ST elevation myocardial infarction (STEMI). Methods:Patients with STEMI admitted in Loghman Hakim hospital were studied. The ECG variables were: ECG rate, ECG rhythm, QRS duration, sum of absolute ST deviation (in all, inferior and anterior leads), number of leads with ST elevation, maximum ST elevation, presence of pathological Q waves and location of the infarct. The primary outcome measure was LVEF ≤ 40%.Results: A total of 124 patients (91 male, 33 female) were studied. Mean age of the patients was 59.1 years (SD=12.6). Of these, 52 patients (44.4%) had an LVEF ≤ 40% and angiography was recommended to 68 patients (54.8%) at the time of discharge. The multivariate analysis showed an association of LVEF ≤ 40% with prior MI, diabetes, maximum creatine kinase (CK) levels, the sum of absolute ST deviation in all and inferior leads. Conclusions:The initial ECG and CK levels in patients with STEMI may contain valuable information for risk stratification, determination of prognosis and the subsequent management plan. The results of this study warrant further studies to define patients who benefit most from invasive and sophisticated interventions.