Accuracy of Clinical Symptoms, Electrocardiographic and Echocardiographic Parameters for Diagnosis of Significant Proximal Right Coronary Artery Lesion in Acute Inferior Wall Myocardial Infarction

Abstract

IntroductionRight ventricular (RV) infarction is one of the major causes of RV contractile dysfunction. RV involvement occurs in 20-50% of inferior infarctions [1]. Patients with RV infarction associated with inferior infarction have much higher rates of significant hypotension, bradycardia requiring pacing, and in-hospital mortality compared to isolated inferior infarction [2] Occlusion of proximal dominant RCA is usually responsible for RV infarction in inferior wall myocardial infarction [3] Results: There were 35 patients with first episode of IWMI, group A (n =14 patients) and group B (n =21patients), There were significant differences between groups in TAPSE (1.28cm vs 1.98 p < 0.001), MPI-TDI (0.69±0.12 vs 0.38±0.05 p < 0.001), and in S'velocity from RV free wall ( 0.09m/s±0.02 vs 0.12m/s ±0.02 p < 0.001). It was found that S'<10cm/s is a predictor of proximal RCA lesion with sensitivity of 92.86% and specificity of 85.71%, ppv 81.25, npv 94.74. MPI-TDI>0.55 had a sensitivity of 92.86 % and a specificity of 100%, 100% PPV and 95.45% NPV. TAPSE<16mm had a sensitivity of 93%, and a specificity of 100%. Conclusion: RV indices (S' velocity, MPI-TDI and TAPSE ) are useful in predicting proximal RCA as infarct related artery in IWMI.

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

“…The present study showed no statistically significant difference between groups regarding demographic data and risk factors, in concordance with the studies of Rajesh et al, El Sebaie et al, and Shetaya et al…”

“…Our study showed that ST‐segment elevation in V 4 R can predict proximal RCA lesion with 70.8% sensitivity and 95.5% specificity, near to the results of many studies …”

“…As 89.5% of patients in group 2 had significant proximal RCA lesion, the present study showed that the means of MPI‐PW and MPI‐DTI were significantly higher in group 2; the means of RV‐ FAC, RV S′‐wave velocity, and TAPSE were significantly lower in group 2, in agreement with Rajesh et al Shetaya et al, Ozdemir et al, and Fan et al Although El Sebaie et al, in discordance with our study, showed that the mean TAPSE was comparable in both groups ( P = 0.89), that can be explained by the fact that TAPSEs carry the inherent limitation of estimating global function of a complex structure from a single‐segment analysis, and also TAPSE has some limitations in that measurement is restricted to longitudinal function of RV free wall and functional status of LV may have an influence on it and it may be affected by foreshortening of the apical 4‐chamber view.…”

“…There were no significant differences in LVEF and time to echocardiography between groups, in agreement with El Sebaie et al and Shetaya et al But the study by Rajesh et al showed that LVEF was significantly lower in the group with proximal RCA lesion …”

“…The present study constructed ROC curves to predict proximal RCA lesion and determined optimal cutoff values of ≤15.5 for TAPSE with 79.2% sensitivity and 84.1% specificity; ≥54.5% for MPI‐DTI with 75% sensitivity and 90.9% specificity; ≥39.5% for MPI‐PW with 79.2% sensitivity and 86.4% specificity; ≤11.5 cm/s for S′ with 75% sensitivity and 86.4% specificity; and ≤42% for RV‐FAC with 83.3% sensitivity and 75% specificity for prediction of proximal significant RCA lesion. Many studies are near to our results, as Rajesh et al whereas others are concordent to some degree …”