Early right ventricular dysfunction after primary percutaneous coronary intervention in anterior versus isolated inferior myocardial infarction assessed by tissue Doppler imaging and speckle tracking echocardiography

Abstract

This study hypothesized that imaging provides information indicating the right ventricular (RV) involvement after anterior or inferior ST-elevation myocardial infarction (STEMI), beyond standard electrocardiogram (ECG) due to the increasing interest in RV function and assessment techniques. This study aimed to compare RV function between anterior and inferior MI without RV involvement using different echocardiographic modalities. This study included 100 patients with anterior (50 patients) and inferior (50 patients) STEMI, who underwent primary percutaneous coronary intervention (PPCI) and two-dimensional echocardiographic imaging within 24 h after PPCI with RV function analysis by left ventricular (LV) infarct size, LV filling pressure, and RV strain rate. Our primary endpoint was the subclinical RV dysfunction in anterior or inferior MI using tissue Doppler and speckle tracking (STE). The study population included 80 (80%) males and 20 (20%) females. Patients with the anterior STEMI had higher mean creatine kinase-MB (CKMB) and troponin than those with inferior STEMI. This study revealed worse RV dysfunction in patients with anterior than those with inferior STEMI, as reflected by significantly lower RV systolic function, tricuspid annular plane systolic excursion (p ≤ 0.0001), tissue Doppler-derived velocity (p ≤ 0.0001), and STE-derived strain magnitude and rate (p ≤ 0.0001). RV dysfunction occurs in patients without ECG evidence of RV STEMI. RV dysfunction is worse in anterior than inferior MI. Moreover, RV systolic functions were affected by declined LV ejection fraction irrespective of the infarction site, which clinically implies prognostic, treatment, survival rate, and outcome improvement between both conditions. (Trial registration ZU-IRB#:4142/26–12-2017 Registered 26 December 2017, email: IRB_123@medicine.zu.edu.eg).

The association between C-reactive protein to albumin ratio and infarct location in patients with ST-segment elevation myocardial infarction

“…We also also observed that patients with anterior STEMI had lower ejection fraction, and higher infarct area measured by the troponin and CK-MB levels. Similarly, it was reported previous studies that anterior STEMI patients had higher level of cardiac enzymes than non-anterior STEMI patients 5,17,27 . These results suggest that the inflammatory response during myocardial infarction may be related to the infarct location and infarct size, as well as a more widespread inflammation is triggered in anterior STEMI.…”

“…On the other studies regarding the frequency of 3-vessels between anterior vs. nonanterior STEMI patients are contradictory. Some previous studies found that the 3-vessel disease frequency was higher in non-anterior STEMI 18,19 , whereas others found no significant difference between the two groups 17,20 . In the current study, although the frequency of the 3-vessel disease tended to be higher in non-anterior STEMI (30.8% vs. 21.9%), we observed that this difference did not reach significance.…”

“…Age, sex, comorbidities, body mass index, blood pressures and the frequency of 3vessel disease were not different between anterior and non-anterior STEMI groups. However, the syntax score (18 [11][12][13][14][15][16][17][18][19][20][21][22] vs. 12 [8][9][10][11][12][13][14][15][16][17][18], p < 0.001) was significantly higher in the anterior STEMI group compared to the non-anterior STEMI group. On the other hand, patients with anterior STEMI had significantly lower ejection fraction compared to the non-anterior STEMI patients (35.84 ± 6.49 vs. 42.58 ± 6.36, p < 0.001) (Table 1).…”

“…Previous studies compared anterior versus nonanterior STEMI patients in terms of baseline and angiographic characteristics. In these studies, it was detected that the anterior and non-anterior STEMI patients had similar baseline clinical characteristics 2,7,17 . We also found that patients with and without anterior STEMI had similar baseline characteristics.…”