Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

Abstract

A B S T R A C T Background:Unlike left ventricular function, less attention has been paid to Right Ventricular (RV) function after Myocardial Infarction (MI). Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group) and 35 ones had anterior MI (AMI group). Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI) measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant. Results:The ratio of early diastolic velocity of the tricuspid flow to early diastolic velocity of the tricuspid annulus in the lateral side (E/E') was significantly higher in the AMI group compared to the IMI group (6.73 ± 1.64 vs. 5.68 ± 1.32, P = 0.01). In addition, abnormal E/E' ratio of the tricuspid valve was present in 27 (77%) and 14 (56%) patients in the anterior and inferior MI groups, respectively. Besides, the RV Tei index was significantly higher in the AMI group compared to the IMI group (0.65 ± 0.11 vs. 0.58 ± 0.13, P = 0.02). Overall, 28 patients (80%) with anterior infarction and 12 patients (48%) with inferior infarction had abnormal RV Tei index. However, no significant difference was found between the two groups regarding other variables. Conclusions: RV dysfunction commonly occurs after a first acute ST-elevation MI. However, RV functional changes are more pronounced in patients with anterior MI.

Early right ventricular dysfunction after primary percutaneous coronary intervention in anterior versus isolated inferior myocardial infarction assessed by tissue Doppler imaging and speckle tracking echocardiography

“…Additionally, LV filling pressure was significantly higher in the anterior MI group (p < 0.001). This data was concordant with Abtahi et al [15] who compared RV function in 60 patients, including 25 in group 1 and 35 in group 2 (acute myocardial infarction). Synchronous LV and RV mechanical dysfunction may be explained by the Torrent-Guasp model as the helical ventricular myocardial band encircles the right and left ventricles with transversely oriented circular myocardial fibers within a basal loop, while intermingled with two differently oriented oblique fibers, directed from right to left within the sub-endocardial muscle and from left to right within the sub-epicardial muscle, crisscross within the interventricular septum and connect in the apex of the heart.…”

“…However, lateral E′ was significantly lower in the anterior MI group compared to the inferior MI group (p = 0.005) while no significant difference between both groups regarding lateral E/e′ (p = 0.185). This data is in disconcordant with the findings of Hsu et al [20], where RV diastolic dysfunction was reported in patients with inferior infarction, whereas Abtahi et al [15] reported no significant differences between both groups regarding RV diastolic functions.…”

“…RV diameter was significantly higher in the anterior MI group compared to the inferior MI group although RV diameter was higher than the normal range in both groups (p < 0.05). These data were discordant with Abtahi et al [15] who observed no significant difference between patients with anterior MI and inferior MI regarding RV and RA diameters. This could be explained by more RV involvement in the first group as it is representative of a more extensive disease.…”

“…From the physiological point of view, given the distribution of the perfusion territories of the major epicardial coronary arteries, inferior MI in most cases is due to RCA stenosis, which supplies both the RV free wall and the base of the interventricular septum and would thus affect most RV functional measurements while anterior MI is usually due to LAD artery stenosis, which does not significantly contribute to RV perfusion other than the RV apex when the LAD artery wraps around the apex [15]. Hence, RV dysfunction is more common in inferior LV infarction due to similar vascularization.…”

Global longitudinal strain as an Indicator of cardiac Iron overload in thalassemia patients

“…Conventional echocardiography which examines such factors as Ejection fraction (EF) and FS (Fractional shortening) is not sufficiently accurate for early diagnosis of cardiac iron overload. Previous studies have shown the benefits of newer echocardiographic techniques such as Strain Imaging [10, 11] and Tissue Imaging [12] for the detection of early and subclinical myocardial dysfunction syndromes. However, most of the studies have compared thalassemia patients with normal population and have ignored a comparison with cardiac MRI findings as the noninvasive gold standard [13] and if this comparison is done only a correlation assessment was done.…”