The value of Doppler-derived myocardial performance index and tricuspid annular motion in the evaluation of the right ventricular function in patients with acute inferior myocardial infarction

摘要

Background: Right ventricular infarction (RVI) accompanies inferior myocardial infarction (IMI) in 30-55% of cases and the proximal segment of the right coronary artery (RCA) is the most common infarct-related artery (IRA). Early successful reperfusion radically improves upon an unfavourable early outcome in patients with IMI. Echocardiography is a valuable method, complementary to electrocardiography (ECG) in the identification of RVI. Tricuspid annular motion (TAM) and myocardial performance index (MPI_R) allow the assessment of RV function independent of any geometrical principle. The aim of the study was to assess the value of MPI_R and TAM in the diagnosis of RVI in patients with a first IMI. Methods: Echocardiography was performed on days 2-3 following IMI in 111 patients. Left (LV) and right (RV) ventricular function was assessed with special attention to the signs of RVI: RV segmental asynchrony (in any available view), RV wall motion score index (WMSIR), MPI_R and TAM. On the grounds of ECG findings two groups of patients were analysed: I - 33 patients with RVI and II - 78 patients with no signs of RVI. Echocardiography parameters of RV function were additionally analysed in two subgroups of patients: A - patients with IRA in the proximal segment of RCA (proxRCA) and B - patients with IRA located elsewhere, as well as in a control group of 24 healthy subjects. Results: Group I and group II were comparable with respect to age, sex, history of angina prior to IMI, multi-vessel disease and left ventricular function. The mean interval between the onset of IMI and admission to hospital was significantly shorter and hypotension (≤ 95 mm Hg) was more often observed in group I than in group II. Segmental asynergy of RV walls was present in 88% of group I and in only 11% of group II (p R (0.42 ± 0.05 vs. 0.29 ± 0.06, p R were revealed (p R higher in the A than in the B subgroups. A sensitivity and specificity test showed that MPI_R ≥ 0.36 and TAM ≤ 19.5 mm argue for RVI. At least one of these abnormal values was noted in all patients with RVI. Coexistence of both abnormal values of MPI_R and TAM was significantly more often observed in group IA than in group IB (91% vs. 73%, p R and TAM increase the probability of a diagnosis of RVI in the same proportion (15.3-time and 15.6-time respectively). Conclusions: In patients with IMI echocardiography parameters - MPI_R and TAM are supplementary to clinical and ECG data and are useful easily obtainable indicators of RVI. In patients with IMI RV dysfunction is related to the localisation of IRA. A sensitivity and specificity test showed that MPI_R ≥ 0.36 and TAM ≤ 19.5 mm argue for RVI. At least one of these abnormal values was noted in all patients with RVI. Coexistence of both abnormal values of MPI_R and TAM was significantly more often observed in group IA than in group IB (91% vs. 73%, p R and TAM increase the probability of a diagnosis of RVI in the same proportion (15.3-time and 15.6-time respectively). Conclusions: In patients with IMI echocardiography parameters - MPI_R and TAM are supplementary to clinical and ECG data and are useful easily obtainable indicators of RVI. In patients with IMI RV dysfunction is related to the localisation of IRA.