Echocardiographic assessment of right ventricular function in first myocardial infarction

Abstract

Aim: The aim is to study the right ventricular (RV) function in patients of first myocardial infarction (MI). Methods: This study compared 25 patients of inferior wall MI (IWMI) with or without RVMI and 20 patients of anterior wall MI (AWMI) with 25 healthy age-matched controls. RV function was assessed using Tei index, tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic (S'), early diastolic (E'), and late diastolic (A') velocities using tissue Doppler imaging (TDI) at first presentation and after 24 h. Results: In patients with IWMI, the Tei index was significantly increased (0.44 ± 0.09 vs. 0.22 ± 0.05; P < 0.001), TAPSE was reduced (1.25 ± 0.32 cm vs. 2.09 ± 0.26 cm; P < 0.001) and tricuspid annular S'(12.04 ± 1.74 cm/s vs. 16.48 ± 3.38 cm/s; P < 0.001) and E' (10.16 ± 2.23 cm/s vs. 12.32 ± 3.74 cm/s; P = 0.006) significantly decreased on TDI, compared to controls. Interestingly, patients with AWMI also had significantly increased Tei index (0.45 ± 0.16 vs. 0.22 ± 0.05; P < 0.001) and reduced TAPSE (1.52 ± 0.35 cm vs. 2.09 ± 0.26 cm; P < 0.001) and tricuspid annular S' (13.4 ± 2.5 cm/s vs. 16.48 ± 3.38 cm/s; P = 0.001) compared to controls. IWMI patients with associated RVMI had significantly reduced TAPSE (1.01 ± 0.24 cm vs. 1.43 ± 0.25 cm; P < 0.001) but did not differ with respect to the Tei index (0.42 ± 0.09 vs. 0.44 ± 0.09; P = 0.56) compared to those without ECG evidence of RVMI. Serial echocardiography showed significant improvements in measures of RV function. Conclusion: RV function is affected in all cases of MI, including AWMI, due to ventricular interaction and interdependence. Furthermore, RV function improves rapidly on follow-up.

Keywords

• right ventricular myocardial infarction
• tricuspid annular plane systolic excursion
• tei index