The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: Transesophageal echocardiographic examination

Abstract

SummaryBackground: The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental.Hypothesis: The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables.Methods: Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow-up was continued from hospitalization to the present.Results: When patients with right atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was

Right Atrial and Right Ventricular Function Assessed by Speckle Tracking in Patients with Inferior Myocardial Infarction

“…Rigid ventricles are highly dependent on the atrial contribution for adequate diastolic filling and maintenance of cardiac output. In RV MI, the dilated and rigid ventricle increases the intracavitary pressure against which the RA must empty, therefore it increases its contractility and diastolic filling as a compensatory mechanism [ 5 ]. RA ischemia is a strong prognostic marker in the follow-up of patients with RV MI that signifies a greater extension of RV ischemic injury and, consequently the development of a subgroup with significantly high-risk RV dysfunction [ 6 ].…”