Prognostic value of right ventricular diastolic dysfunction in patients with inferior ST-elevated myocardial infarction
Tóm tắt
Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricular dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not routinely evaluate RV diastolic dysfunction. In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI.
Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Patients with pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (E′, A′ and E/E′ ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period. The average age of the study population was 51.58 ± 10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary edema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 h. Patients who developed MACE had high filling pressures, as all of them had E/E′ > 6. E′ velocity ≤ 6 cm/sec was associated with increased MACE as 25% of patients with E′ velocity ≤ 6 had MACE compared with 2.3% of patients with E′ velocity > 6 with a
Tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/E′ and E′ velocity have a prognostic value in patients with inferior STEMI and RV infarction; E/E′ > 6 and E′ velocity ≤ 6 cm/sec were associated more MACE in patients with inferior STEMI and RVI.
Từ khóa
Tài liệu tham khảo
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177
Ondrus T, Kanovsky J, Novotny T, Andrsova I, Spinar J, Kala P (2013) Right ventricular myocardial infarction: from pathophysiology to prognosis. Exp Clin Cardiol 18(1):27–30
Berger PB, Ryan TJ (1990) Inferior myocardial infarction. High-risk Subgroups Circ 81(2):401–411
Haji SA, Movahed A (2000) Right ventricular infarction–diagnosis and treatment. Clin Cardiol 23(7):473–482
Goldstein SA, Kronzon I, Khandheria B (2016) ASE’s Comprehensive echocardiography, 2nd edn. American Society of Echocardiography (ASE), Philadelphia, pp 149–158
Wu VC, Takeuchi M (2018) Echocardiographic assessment of right ventricular systolic function. Cardiovasc Diagn Therapy 8(1):70
Inohara T, Kohsaka S, Fukuda K, Menon V (2013) The challenges in the management of right ventricular infarction. Eur Heart J Acute Cardiovasc Care 2(3):226–234
Pabich WL, Nicoara A, Sawaminathan M (2012) Ventricular function. In: Oxorn D (ed) Intraoperative echocardiography, expert consult: online and print, 1st edn. Saunders, Philadelphia, pp 131–160
Haddad F, Hunt SA, Rosenthal DN, Murphy DJ (2008) Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 117(11):1436–1448
Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK et al (2018) Evaluation and management of right-sided heart failure: a scientific statement from the American heart association. Circulation 137(20):e578–e622
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23(7):685–713
(2017) Lancellotti P, Zamorano J, Badano L, Habib G (eds) The EACVI textbook of echocardiography. Oxford University Press, pp 403–417
Steele L, Lloyd A, Fotheringham J, Sultan A, Iqbal J, Grech ED (2015) A retrospective cross-sectional study on the association between tobacco smoking and incidence of ST-segment elevation myocardial infarction and cardiovascular risk factors. Postgrad Med J 91(1079):492–496
Jimenez-Quevedo P, Brugaletta S, Cequier A, Iñiguez A, Serra A, Mainar V, Campo G, Tespili M, Nombela-Franco L, Del Trigo M, Gonzalo N, Escaned J, Salinas P, Nuñez-Gil I, Fernandez-Perez C, Fernández-Ortiz A, Macaya C, Serruys PW, Sabate TM (2019) Long-term impact of diabetes in patients with ST-segment elevation myocardial infarction: insights from the EXAMINATION randomized trial. Catheter Cardiovasc Interv 94(7):917–925
Antoni ML, Scherptong RW, Atary JZ, Boersma E, Holman ER, van der Wall EE et al (2010) Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging 3(3):264–271
Kakouros N, Cokkinos DV (2010) Right ventricular myocardial infarction: pathophysiology, diagnosis, and management. Postgrad Med J 86(1022):719–728
Mertens L, Khairy P (2013) Right ventricular diastolic function in congenital heart disease. Can J Cardiol 29(7):755–756
Altıntaş B, Yaylak B, Ede H, Altındağ R, Baysal E, Bilge Ö et al (2019) Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI. Herz 44(2):155–160
Granrud GA, Vatterott PJ (1991) Arrhythmias and acute myocardial infarction. Postgrad Med 90(6):85–88