Radionuclide assessment of right-ventricular involvement in inferior acute myocardial infarction: clinical correlations and in-hospital follow-up

Abstract

We studied 33 patients (28 males, 5 females) with first inferior acute myocardial infarction (AMI) and 12 normal volunteers. They underwent first-pass (FP) and equilibrium-gated radionuclide angiography (EGRA) within 4 days of the onset of symptoms. The parameters [ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR)] of the time-activity curve (TAC) of both ventricles [left ventricle (LV), right ventricle (RV)] were computed. The regional wall motion (RWM) was evaluated by parametric images (amplitude and phase). In 43% of the patients with AMI, we found a depressed RVEF, while the LVEF was decreased in only 33%. The sensitivity of diastolic parameters was shown to be clearly superior to that of the systolic parameters (RVPFR, 78%; LVPFR, 79%). The abnormalities of the overall performance of both ventricles were significantly correlated with those of the RWM. The abnormal RVEF allowed us to assess the necrotic involvement of the RV, while a depressed RVPFR suggested an impaired RV compliance mostly on an ischemic basis. Congestive heart failure (CHF) and shock syndrome were significantly correlated with depressed RV parameters, while the LVEF, despite RWM abnormalities, was in the normal range. EGRA with computation of the TAC parameters of both ventricles appeared to be useful for in-hospital prognostic evaluation, therapeutic planning and clinical follow-up of patients with inferior myocardial infarction.

Right and Left Ventricular Dysfunction in Inferior Acute Myocardial Infarction

“…Accordingly, we found RVI in 47% of our patients, in agreement with other radionuclide studies [8,10,11,21]. RVEF depres sion appeared to be due to progressively more extended and severe involvement of the right ventricular free wall and not of the interventricular septum, as suggested by other authors [22,23].…”

“…In our series, the incidence of CHF appears to be strictly related to RVD, but not to LVD. This finding is in agreement with the report of Daubert et al [ 13] and confirms our previous report [11].…”

“…The diagno sis of RVI has been established by many different techniques: necropsy [1][2][3][4], haemodynamic evaluation [5], electrocardiography [6,7], 99mTc-pyrophosphate scan [8], equilibrium radionuclide angiography [9][10][11], and echocardiography [8,12,13]. Despite the high in cidence of complications during the acute stage, pa tients with RVI have a good overall prognosis [5,6,[14][15][16].…”

“…The background value was calculated from the end-systolic frame by using the average count per pixel in the area between end-diastolic and end-systolic regions of interest. Our method for the assessment of LVEF and RVEF has been previously validated [11,20]. The evaluation of regional wall motion (RWM) of the left ventricle was performed using the functional images of amplitude and phase obtained by Fourier analysis of scintigraphic data.…”

Biventricular function in Friedreich's ataxia: a radionuclide angiographic study.

“…A computer program gated to the electrocardiogram (SYMA, Elscint) collected and organised scintigraphic data into a series of24 frames on a matrix of64 x Biventricular function in Friedreich's ataxia: a radionuclide angiographic study 64 pixels that spanned the average cardiac cycle. The method has been validated for the assessment of the ejection fraction of both ventricles.9 10 We studied each patient in a left anterior oblique 35-45' projection and in a projection obtained by turning the crystal 400 counterclockwise. Twenty four points that were representative of the volume curve for each ventricle were transferred to a memory of a desk computer (Hewlett-Packard 85) and fitted with a Fourier series; the first four harmonics were usually retained. "…”