Acute inferior myocardial infarction with right ventricular involvement and several clinical‐electrocardiographic markers of poor prognosis

García‐Niebla, Javier; Pérez‐Riera, Andrés Ricardo; Barbosa‐Barros, Raimundo; Díaz-Muñoz, Jorge; Daminello‐Raimundo, Rodrigo; Abreu, Luíz Carlos de; Nikus, Kjell

doi:10.1111/anec.12592

Cited by 5 publications

(6 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In nearly half of acute inferior STEMI patients, the right ventricle is affected by acute myocardial infarction (AMI) mostly due to occlusion of the right coronary artery (RCA) proximal to the right ventricular (RV) branch[ 1 ]. Due to multiple factors the right ventricle is less affected by ischemia than the left ventricle (LV) [ 2 ], however when acute RV ischemia complicates acute inferior STEMI, it leads to poor clinical outcome especially short term one due to increased risk of arrhythmias and hemodynamic instability [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Right Atrial Volume Index as a Predictor of Persistent Right Ventricular Dysfunction in Patients with Acute Inferior Myocardial Infarction and Proximal Right Coronary Artery Occlusion Treated with Primary Percutaneous Coronary Intervention

Naseem¹,

Samir²

2021

Journal of the Saudi Heart Association

View full text Add to dashboard Cite

Objectives Patients with right ventricular (RV) infarctions associated with inferior infarctions have higher rates of adverse events than isolated inferior infarctions. Right atrial volume index (RAVI) has recently been described as a predictor of clinical outcome in patients with chronic systolic heart failure and pulmonary hypertension. The aim of this study is to assess the ability of RAVI to predict the persistent RV dysfunction after acute inferior STEMI due to occlusion of proximal RCA. To the best of our knowledge, this is the first study to investigate the relation between RAVI and persistent RV dysfunction in such group of patients. Patients and methods Sixty-five consecutive patients with recent first acute inferior STEMI who underwent primary percutaneous coronary intervention (PPCI) were prospectively included in the study. Echocardiographic evaluation was performed at the time of discharge and at 3 months. All the patients underwent standard echocardiographic assessment using conventional 2D and tissue Doppler imaging (TDI). Results Patients were divided into two groups according to right ventricular function (RVF) 3 months after acute myocardial infarction (AMI). The normal RVF group included 41 (63%) patients and the impaired RVF group included 24 (37%) patients. RAVI was significantly higher in patients with impaired RVF (p=<0.001). RAVI was a predictor of persistently impaired RV function (odds ratio = 1.786, 95% confidence interval, 1.367–2.335, p value= <0.001) and (odds ratio = 1.829, 95% confidence interval, 1.358–2.462, p value= <0.001) in univariate and multivariable logistic regression analyses respectively. In receiving operator characteristics (ROC) curve analysis, RAVI with a cutoff value ≥ 30 ml/m 2 had a 87.5% sensitivity, a 92.24% specificity area under Receiving operator characteristics (ROC) curve = 0.964 for predicting persistently impaired RVF. Conclusion In patients with inferior STEMI with proximal RCA occlusion, RAVI is an independent predictor of persistently impaired RVF with a cut-off value ≥ 30 ml/m 2 .

show abstract

Section: Introductionmentioning

confidence: 99%

Right Atrial Volume Index as a Predictor of Persistent Right Ventricular Dysfunction in Patients with Acute Inferior Myocardial Infarction and Proximal Right Coronary Artery Occlusion Treated with Primary Percutaneous Coronary Intervention

Naseem¹,

Samir²

2021

Journal of the Saudi Heart Association

View full text Add to dashboard Cite

show abstract

“…The incidence of isolated right ventricular myocardial infarction is rare, accounting for merely 2% of autopsies [2]. Despite its rarity, right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarction and 10% anterior myocardial infarction [2][3][4]. This condition poses unique diagnostic and management challenges and is often associated with higher in-hospital morbidity [2,5].…”

Section: Introductionmentioning

confidence: 99%

“…Right ventricular myocardial infarction presents with typical manifestations of myocardial infarction such as chest pain, nausea, vomiting and diaphoresis [3,6]. It is often accompanied by a haemodynamic triad of hypotension, elevated jugular venous pressure and clear lung fields [2][3][4]6]. The correct and early diagnosis of right ventricular myocardial infarction improves clinical outcomes, decreases electrical and mechanical complications and improves overall short-term and long-term prognoses [3,4].…”

Section: Introductionmentioning

confidence: 99%

Kussmaul’s sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies

et al. 2021

View full text Add to dashboard Cite

Introduction Kussmaul's sign, the absence of a drop in jugular venous pressure or a paradoxical increase in jugular venous pressure on inspiration, can be evaluated as an indicator of right ventricular myocardial infarction. Right ventricular myocardial infarction complicates 30-50% of inferior myocardial infarctions and is associated with increased mortality when compared to inferior myocardial infarction without right ventricular involvement. Early recognition allows maintenance of preload. We reviewed the diagnostic test accuracy studies for Kussmaul's sign for diagnosis of right ventricular myocardial infarction. Methods We conducted a librarian-assisted search using PubMed, Medline, Embase, and the Cochrane database from 1965 to October 2019. Only English language restriction was imposed. We identified studies that assessed patients presenting to a hospital with a suspected myocardial infarction who underwent an assessment for Kussmaul's sign and a diagnostic test for right ventricular myocardial infarction. Four independent reviewers extracted data from relevant studies. Study quality was assessed using the QUADAS-2 tool. A bivariate random effects meta-analysis was performed. Results We identified 122 studies; ten were selected for full review. Eight studies had comparable populations with a total of 469 consecutive patients admitted with acute inferior myocardial infarction and were included in the analysis. Prevalence of right ventricular myocardial infarction was 36% (confidence interval [CI] 95% 31.8-40.5). All reference standards were combined. Kussmaul's sign had a sensitivity of 62.5% (44.6, 77.5), specificity 90% (73.0, 96.8), negative likelihood ratio (LR) 0.2 (0.1-0.8) and positive LR 5.8 (2.5, 13.3). ConclusionIn the presence of acute myocardial infarction, Kussmaul's sign is specific for acute right ventricular myocardial infarction and may serve as an important clinical sign of right ventricular dysfunction requiring preload preserving management.

show abstract

“…Right ventricular myocardial infarction (RVMI) accompanies around 30-50% of inferior wall MI [5], yet, isolated RVMI is a rare case [6,7]. The fourth universal definition of MI suggests that diagnosis of RVMI should be based on ECG findings (ST-segment elevation in leads V3R and V4R ≥0.5 mm or ≥1 mm in men under 30 years old).…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction

Neverauskaite-Piliponiene

Kūgienė

Petrulionienė

et al. 2019

Seminars in Cardiovascular Medicine

View full text Add to dashboard Cite

Summary Right ventricular myocardial infarction (RVMI) accompanies about 30–50% of inferior wall myocardial infarction. RVMI is associated with higher rates of cardiogenic shock, atrioventricular block, atrial fibrillation, increased mortality rates. The topic requires a scientific update, as only a few studies have been made on RVMI during the past decade. We aimed to analyse the impact of RVMI on inferior myocardial infarction. Design and methods: Retrospective study included 310 patients with documented inferior myocardial infarction (with and without RVMI) between January 2013 and January 2014. Data on baseline characteristics, mortality, in-hospital complications: cardiogenic shock and rhythm and conduction disorders was collected. Results: In 102 (32.9%) patients with inferior myocardial infarction, RVMI was present and 208 (67.1%) cases were without RVMI involvement. RVMI patients had higher rate of rhythm and conduction disturbances than patients without RVMI involvement: atrioventricular block (OR 3.8, 95% CI 2.0–7.1, p < 0.001), atrial fibrillation (OR 1.6, 95% CI 0.9–2.9, p = 0.001), also higher incidence of cardiogenic shock (OR 2.6, 95% CI 1.7–3.9, p < 0.001). Mortality rates after 24 months were higher in RVMI group (OR 1.8, 95% CI 1.2–3.8, p = 0.034). No significant difference was found on in-hospital mortality. Conclusions: Right ventricular involvement complicates the long-term mortality and outcomes after inferior myocardial infarction. It is related to a higher incidence of in-hospital complications, especially I–III degree AV block and atrial fibrillation. However, influence on long-term mortality needs further investigation.

show abstract

Acute inferior myocardial infarction with right ventricular involvement and several clinical‐electrocardiographic markers of poor prognosis

Cited by 5 publications

References 7 publications

Right Atrial Volume Index as a Predictor of Persistent Right Ventricular Dysfunction in Patients with Acute Inferior Myocardial Infarction and Proximal Right Coronary Artery Occlusion Treated with Primary Percutaneous Coronary Intervention

Right Atrial Volume Index as a Predictor of Persistent Right Ventricular Dysfunction in Patients with Acute Inferior Myocardial Infarction and Proximal Right Coronary Artery Occlusion Treated with Primary Percutaneous Coronary Intervention

Kussmaul’s sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies

Retrospective analysis of complications and survival in patients with acute inferior myocardial infarction accompanied by right ventricular myocardial infarction

Contact Info

Product

Resources

About