Right ventricular function in ST elevation myocardial infarction: Effect of reperfusion

Abstract

Acute myocardial infarction (AMI) is still among the major causes of mortality and morbidity especially in the developed countries. There are two treatment modalities: primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT). The Tei Index (Myocardial Performance Index) has become a valuable echocardiograhic index for assessment of global systolic and diastolic function. TDI Tei index correlates with pulsed wave measurements. 1,2 Tei index provides prognostic information in patients with dilated cardiomyopathy, cardiac amyloidosis, acute myocardial infarction congenital heart disease and primary pulmonary hypertension. [3][4][5][6][7][8][9][10][11] Increased Tei index is a strong predictor of mortality and morbidity after acute myocardial infarction. [9][10][11] Duan Y et al. demonstrated that RV TDI Tei index correlated well with the Tei index obtained by pulsed Doppler in fetuses. This demonstrated that RV TDI Tei index is a simple and valuable method of assessing RV global function even in seldom evaluated subjects such as fetuses. 12 Even if the right ventrincle has not faced ischemia it may be affected by left ventricle ischemia. In the GISSI-3 Echo Substudy, RV function deteriorated in acute MI patients and RV function recovery over time ORIGINAL RESEARCH

Assessment of right ventricular function after successful revascularization for acute anterior myocardial infarction without right ventricular infarction by echocardiography

“…Similar to our data, Karakurt and Akdemir [12] reported that the RV global function assessed by RV TDI was depressed in anterior STEMI, but not in inferior STEMI regardless of the reperfusion strategy.…”

“…The lower incidence of RV involvement in the studies by Hsu et al [4] and Karakurt and Akdemir [12] than in our study could be explained by higher risk profile of our patients such as diabetes mellitus (DM; 87.5%) in our study, 28.5% in Hsu et al study [4], and 25.9% in Karakurt and Akdemir study [12], which may affect the microvascular integrity leading to higher incidence of RV involvement.…”

The change in right ventricular systolic function according to the revascularisation method used, following acute ST -segment elevation myocardial infarction

“…In a study by Karakurt et al , patients who were managed with PPCI following non-anterior STEMI were compared to those who received TT alone, and similar mean RV-MPIs were observed in both groups at 72 hours after the infarction 23. In our study, there was no difference between the groups in terms of mean RV-MPI values observed before percutaneous intervention and at the one-month follow up.…”

“…It can be measured from the tricuspid lateral annulus by means of tissue Doppler. RV-S′ < 10 cm is associated with RV systolic dysfunction 13,23,27. In our study there were no significant differences between the groups in the early period and at the one-month follow up according to mean RV-S′.…”

Right ventricular function in patients presenting with non-ST-segment elevation myocardial infarction undergoing an invasive approach

“…Also, Ozlem et al reported that 22% of their study population presenting with anterior STEMI and underwent primary PCI or received thrombolytic therapy had abnormal myocardial performance index (MPI) 15 . Our study showed a higher prevalence of RV involvement because of the higher risk profile of our patients such as DM (62.7% in our study), 28.5% in Shun’s study and 25.9% in Ozlem’s study.…”