Right Ventricular Function Suffers From Reperfusion Delay: Tissue Doppler Study

Abstract

In this study, impact of reperfusion delay on adverse cardiac events and right ventricular (RV) function in patients with acute right ventricular myocardial infarction (RVMI) was assessed. In 70 patients with RVMI, RV function was assessed by M-mode tricuspid annular plane systolic excursion (TAPSE) and by pulsed wave tissue Doppler echocardiography (TDE). Right ventricular early (E T ) and late diastolic (A T ), peak systolic tricuspid annular velocity, (S T ) and right ventricular myocardial performance index (RVMPI) were measured. Patients were divided into 2 groups according to the time between the onset of symptoms and percutaneous transluminal coronary angioplasty (PTCA)-group 1 (n = 25), 3 hours and group 2 (n = 45), >3 hours. During 30-day follow-up, we assessed adverse cardiac events like the following: death, cardiogenic shock, need for intra-aortic counterpulsation, temporary transvenous pacing support (PCM), presence of ventricular septal defect (VSD), cardiac tamponade, or free wall rupture. Results: Group 1 had significantly higher values of E T , S T , and TAPSE than group 2. RVMPI was significantly elevated in group 2. A total of 13 (18.2%) patients had a cardiac event, 5 patients (7.1%) died. We observed an increase of cardiac events in patients with reperfusion delayed more than 3 hours (P = .056). Conclusion: TAPSE-derived and TDE-derived right ventricular systolic and early diastolic velocities were less affected in patients with shorter time from pain onset to opening of the occluded right coronary artery (RCA). Presented initial data show that the tissue Doppler technique may be useful for identification of patients with RV infarction with higher rate of adverse cardiac events including death.

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

“…We also found patients with proximal or mid LCX lesions as well as patients with no reflow and worse procedural events to be correlated with RV dysfunction. Kidawa et al [14] found results similar to those of our study.…”

“…Kidawa et al [14] found that 64% of their patients had RV dysfunction measured by TAPSE; this higher incidence may be explained by the fact that they included all STEMI patients with possible occurrence of RV infarction in addition to the different assessment parameters.…”

Right ventricular myocardial infarction: pathophysiology, diagnosis, and management

“…Reperfusion within 1 h of occlusion leads to immediate recovery of RVFW function and consequent improved LV filling and performance 20. Delayed reperfusion after 4–8 h is associated with a higher degree of RV dysfunction and complications, but still results in significant, yet slower, recovery of RV function 129 130. Failure to reperfuse the RCA, and in particular the RV branches, leads to lack of recovery in the acute setting and consequent haemodynamic compromise, which is associated with high in-hospital mortality.…”

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

“…This could be explained by the more prevalent affection of the micro vascular integrity and more macrovascular beds affection leading to higher incidence of RV involvement. On the other hand, Kidawa et al, 16 found that 64% of the patients present with STEMI and underwent primary PCI had RV dysfunction measured by TAPSE, this higher incidence may be explained by the fact that Kidawa et al’s study population included all STEMI patients with non-anterior STEMI and possible occurrence of RV infarction in addition to the different assessment parameters 16 …”