Echocardiographic Assessment of Right Ventricular Function in Inferior Wall Myocardial Infarction

Gayathri, M S (2020) Echocardiographic Assessment of Right Ventricular Function in Inferior Wall Myocardial Infarction. Masters thesis, Stanley Medical College, Chennai.

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Abstract

BACKGROUND: Acute coronary syndrome with Inferior wall myocardial infarction (IWMI) is a commonly encountered medical emergency, most often due to occlusion of right coronary artery and less commonly due to occlusion of left circumflex coronary artery. Right Ventricular Myocardial Infarction (RVMI) is a common complication of acute inferior MI. In recent years, right ventricular MI seems to be underdiagnosed in most cases of acute coronary syndrome, despite its frequent association with inferior wall MI. Right ventricular dysfunction adversely affects left ventricular function by decreasing preload and by the phenomenon of ventricular interdependence. The presence of right ventricular infarction poses a higher risk of adverse events (hemodynamic compromise and arrhythmias) in inferior wall myocardial infarction and thus right ventricular involvement in a patient with IWMI is considered to be an independent prognostic factor that increases in-hospital mortality rate. METHODS: In this study, 75 patients presenting with their first episode of acute Inferior Wall Myocardial Infarction, within 12 hours of symptom onset, were enrolled. They were diagnosed based on ECG criteria and elevated cardiac biomarkers. They were then grouped into those with isolated IWMI and those with IWMI+ Right Ventricular MI/Posterior Wall MI based on ECG. These patients underwent echocardiographic assessment within 24 h of symptom onset and indices of Right Ventricular function like RV Diastolic dysfunction, TAPSE (tricuspid annular plane systolic excursion), Myocardial Performance Index and RV wall motion abnormality were obtained. RESULTS: Out of 75 patients enrolled, 39% had ECG evidence of RVMI/PWMI. Electrocardiography in the diagnosis of RVMI was not as sensitive which mandates the need for echocardiography. There was significant difference found in those with IWMI (n= 46) and IWMI+RVMI/ PWMI (n = 21+8) with respect to TAPSE (mean 21.76 vs 16.17, p < 0.001), MPI by tissue Doppler (0.43 vs 0.72, p < 0.001), RV wall motion abnormalities (13.6% vs 93.6%, p <0.001) and E/A ratio (1.12 vs 1.45 p < 0.001) and Left Ventricular EF (57.76 vs 50.17). RV MPI had a higher sensitivity in predicting right ventricular involvement. RV involvement in a patient with IWMI is an independent risk factor for major complications like conduction disturbances, arrhythmias and cardiogenic shock. CONCLUSION: ◈ There was no significant difference with respect to age, sex or symptoms at presentation in those with right ventricular myocardial infarction. ◈ Electrocardiography in the diagnosis of RVMI is not as sensitive which mandates the need for echocardiography. ◈ Right ventricular wall motion abnormalities, of RV diastolic dysfunction, Right ventricular Myocardial performance index, Tricuspid annular plane systolic excursion (TAPSE) are useful echocardiographic parameters in the assessment of right ventricular dysfunction. Of these, the RV MPI had a higher sensitivity in predicting right ventricular involvement and mortality. ◈ RV involvement in a patient with IWMI is an independent risk factor for major complications like conduction disturbances and cardiogenic shock. ◈ Though the in-hospital mortality after acute inferior MI did not differ much in those with IWMI and IWMI+RVMI in our study, this was probably attributed to the smaller sample size of the study group.

Item Type: Thesis (Masters)
Additional Information: 201711054
Uncontrolled Keywords: Inferior Wall Myocardial Infarction (IWMI), Right Ventricular Myocardial Infarction (RVMI), RV Diastolic dysfunction, Tricuspid Annular Plane Systolic Excursion (TAPSE), Myocardial Performance Index, RV wall motion abnormality.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 28 Jan 2021 10:40
Last Modified: 28 Jan 2021 10:40
URI: http://repository-tnmgrmu.ac.in/id/eprint/13225

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