Assessment of right ventricular functional recovery after acute myocardial infarction by 2D speckle-tracking echocardiography

Abstract

To assess the pattern of right ventricular (RV) functional recovery in a cohort of patients with successful reperfusion of a first episode of acute myocardial infarction (AMI) with 2D speckle-tracking echocardiography and cardiac magnetic resonance imaging (CMR). Ninety-five revascularized AMI patients were prospectively included (56.8 ± 11.1 years, 48 inferior, 47 anterior). RV function was assessed by echocardiography and CMR within the initial 72 h and 6 months later. A RV global strain was calculated while averaging strain values from septal, lateral and inferior walls. At the acute phase, RVEFCMR was lower in inferior than in anterior AMI patients (52.5 ± 6.8 vs. 56.0 ± 4.8, p = 0.006). Similarly, RV global, inferior and lateral strains were lower in inferior MI patients (p < 0.001 for all) whereas septal strain was not significantly different across groups. At 6 months, RVEFCMR and all strain parameters improved compared to baseline. Improvements were more substantial for patients with inferior than with anterior MI. RV parameters ultimately reached similar levels in the two groups at 6 months except for inferior strain which remained lower in patients with inferior MI (-24.5 ± 6.5 vs. -27.5 ± 5.4, p = 0.03). In low risk patients after AMI, RV function ultimately recovered over the 6 months of follow up. Higher levels of both initial impairment and subsequent recovery were observed for inferior MI. Although RV function was relatively preserved in these patients, RV strain analysis revealed a persistent impairment of RV inferior strain in patients with inferior MI, which may not be identified by RVEFCMR or conventional echocardiographic parameters.

COPD and acute myocardial infarction

“…Studies concerning the assessment of RV systolic function after AMI in patients with COPD are lacking. In addition, although the general population frequently show RV functional recovery after AMI, this remains unknown among COPD patients who might already have subclinical damage [69]. Therefore, future research on this subject is required in order to elucidate the influence of COPD on RV function after AMI and the subsequent prognostic implications.…”

Right Ventricular Function in Coronary Slow Flow: A 2D Speckle Tracking Echocardiography Study

“…[21][22][23][24] However, although this modality was initially used to analyze LV function, it is currently applicable to the evaluation of RV function in many A recent study demonstrated that in patients with CSFP, nicorandil treatment raised nitric oxide levels, conditions such as RV myocardial infarction and coronary artery disease. [25][26][27][28] in other LV segments. The authors concluded that the change in nitric oxide and endothelin levels may not be parallel to the change in function of all LV segments.…”

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

“…In acute phase of myocardial infarction, RV strain is more efficient than conventional RV parameters in detecting RV dysfunction. 32 Furthermore, a large retrospective study has demonstrated that RVGLS (with cutoff value ≥−15.5%, area under curve (AUC)=0.742, sensitivity of 73%, specificity of 65%) has an additive predictive value to age while evaluating the 5-year prognosis in patients after inferior ST-segment elevation myocardial infarction (STEMI), particularly in those with preserved LV ejection fraction. 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.…”