Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion

Abstract

Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p < 0.0001). The RV-LS correlated with the scar extent (r = 0.83, p < 0.0001). RV-LS > -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS <-20%), G2-RV stunning (baseline RV-LS >-20%, 5th day RV-LS <-20%) and G3-persistent RV dysfunction (unchanged RV-LS > -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

High‐risk inferior myocardial infarction: Can speckle tracking predict proximal right coronary lesions?

“…Hutyra et al constructed ROC curves to pedict RV scar by cardiac magnetic resonance imaging in IWMI patients and considered a cutoff value ≥ − 15.8% for RV peak systolic longitudinal strain (RV‐LS) with 92% sensitivity and 83% specificity for RV scar prediction (AUC: 0.93; P < 0.0001) and showed that RV‐LS was superior to TAPSE and TDI in determining the presence of RV scar …”

The State of the Right Ventricle in the Idiopathic Blockage of the Right Crus of Atrioventricular Bundle

“…Оценка систолической функции ПЖ включает привычно используемые методики, такие как фракция изменения площади ПЖ (FAC), экскурсия трикуспидального кольца в М-режиме (TAPSE), систолическая скорость трикуспидального кольца в режиме импульсно-волнового тканевого Допплера (Sta) и новые технологии, основанные на оценке деформации стенки ПЖ (GlStRV). Наибольшее внимание в последние годы приковано именно к методике двухмерной деформации ПЖ (2D-STI), показавшей высокую точность в оценке сократительной способности ПЖ по сравнению с рутинно используемыми технологиями и позволяющей делать прогностическую оценку при СН [13,14]. Наконец, показатели деформации ПЖ могут использоваться для мониторинга его функции при назначении лекарственных препаратов, например, силденафила [15].…”

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

“…10 Similar results, provided by a meta-analysis of patients with inferior STEMI, associated RV involvement with adverse clinical events that were not due to more extensive infarction of the LV, but related rather to an increased propensity to develop life-threatening ventricular arrhythmias. 33 According to Hutyra et al, 34 35 Further prospective studies are needed to validate the ability of using RV strain to identify patients at a high risk for adverse outcomes.…”