Quantifying longitudinal right ventricular dysfunction in patients with old myocardial infarction by using speckle-tracking strain echocardiography

Abstract

BackgroundWe investigated longitudinal right ventricular (RV) function assessed using speckle-tracking strain echocardiography in patient with myocardial infarction (MI), and identified the contributing factors for RV dysfunction.MethodsWe retrospectively studied 71 patients with old MI (the OMI group) and 45 normal subjects (the Control group) who underwent a transthoracic echocardiography. Global and free wall RV peak systolic strains (PSSs) in the longitudinal direction were measured by using speckle-tracking strain echocardiography. Left ventricular (LV) PSSs were measured in the longitudinal, radial and circumferential directions. Cardiac hemodynamics including peak systolic pulmonary artery pressure was also assessed non-invasively. Plasma brain natriuretic peptide (BNP) levels were measured in all patients.ResultsIn the OMI group, 73% of the patients had a normal estimated peak systolic pulmonary artery pressure of less than 35 mmHg. Global and free wall RV PSS were impaired in the OMI group compared with the Control group, and these RV systolic indices were significantly associated with heart rate, logarithmic transformed plasma BNP, greater than 1 year after onset of MI, Doppler-derived estimated pulmonary vascular resistance, LV systolic indices, LV mass index, infarcted segments within a territory of the left circumflex artery and residual total occlusion in the culprit right coronary artery. Multivariable linear regression analysis indicated that reduced longitudinal LV PSS in the 4-chamber view and BNP levels ≥500 pg/ml were independently associated with reduced global and free wall RV PSS. Moreover, when patients were divided into 3 groups according to plasma BNP levels (BNP <100 pg/ml; n = 31, 100 ≤BNP <500 pg/ml; n = 24, and BNP ≥500 pg/ml; n = 16), only patients with BNP ≥500 pg/ml had a strong correlation between RV PSS and longitudinal LV PSS in the 4-chamber view (r = 0.78 for global RV PSS and r = 0.71 for free wall RV PSS, p <0.05).ConclusionLongitudinal RV systolic strain depends significantly on longitudinal LV systolic strain especially in patients with high plasma BNP levels, but not on estimated peak systolic pulmonary artery pressure. These results indicate that process of RV myocardial dysfunction following MI may be governed by neurohormonal activation which causing ventricular remodeling rather than increased RV afterload.

AFC1 Compound Attenuated MI/R-Induced Ventricular Remodeling via Inhibiting PDGFR and STAT Pathway

“…In this study, we reported for the first time the cardioprotective actions of AFC1 in murine MI/R models. Ventricular remodeling including cardiac hypertrophy and fibrosis is the leading cause contributing to cardiac dysfunction after MI/R (Konishi et al, 2013). The key findings of the present study are that administration of AFC1 effectively reduced the cardiac myocyte hypertrophy and fibrosis on day 30 post MI/R, accompanied by significant improvement of cardiac function, and also inhibited MI/R-induced cardiac remodeling in vivo .…”

Evaluation of the right atrial phasic functions in patients with anterior ST-elevation myocardial infarction: a 2D speckle-tracking echocardiography study

“…They, however, failed to define the time of echocardiography after ASTEMI, and they used an echocardiography modality that was not only dependent on the ultrasound beam angle but also associated with low spatial resolution, high noise, and interobserver variability [ 27 ]. Still, it seems that echocardiography was not capable of detecting this damage to the RV in all patients with ASTEMI [ 28 , 29 ]. Similar to Nourian et al, we found that RA reservoir and conduit functions were impaired in patients with ASTEMI, while we detected no significant impairment in RV function in the same phase.…”

Unmasking right ventricular dysfunction in chronic rheumatic mitral regurgitation

“…This results in the division of the RV into six standard segments in the A4C view. 10,23,24 The region of interest, once created, can be manually adjusted as needed to allow for adequate speckle-tracking. 6 The RV free-wall PSS was obtained by averaging three lateral segments (the basal, mid and apical RV wall).…”

“…25 The interventricular septum was excluded from analysis. 23,24 The longitudinal ε curves for each segment and a mean curve of all segments was generated by the software. These curves were used to derive peak negative RV free-wall PSS.…”