Assessment of right ventricular function in patients with successful primary percutaneous coronary intervention for acute anterior ST elevation myocardial infarction without right ventricular infarction by Echocardiography

Abstract

RV involvement in acute LV MI is frequently underestimated in the clinical setting owing to the diagnostic limitations of the electrocardiogram (ECG) and echocardiography. The myocardial performance index (MPI) of RV based on conventional Doppler echocardiography has been proven to be a sensitive tool for detecting "occult" RV dysfunction in acute LV MI, but the conventional Doppler-derived MPI has a limitation as the interval between the end and onset of tricuspid inflow and the ejection time are measured sequentially and not on the same cardiac cycle. In contrast, tissue Doppler imaging (TDI) can simultaneously measure these important time intervals on the same cardiac cycle, making the TDI derived MPI superior in the estimation of global RV function. Aim of the study was to assess right ventricular function in patients presented to Ain Shams university hospital with first acute anterior STEMI who underwent successful primary PCI. Labs and Demographic procedural details were carefully collected, Echocardiography was done to assess the left and right ventricular systolic and diastolic function with special comment on TAPSE, RVEDD, RAA, RVFAC, and tissue Doppler derived MPI. The mean age was (45.9 ± 7.60 years). Most of our study population were males representing 55% of study population. The most prevalent risk factor was DM (87.5%), followed by hypertension (75%), and smoking was (67.5%). RV Dysfunction in first Anterior MI occured in (47.5%) of the study population using the definition of a combination of (RV EDD >26mm, RV FAC <35%, RAA >20 cm2, and TAPSE <16 mm), while Abnormal MPI occured in (55%) of the study population using the definition if MPI >0.55. (Age, Pain to door, Predilatation, Glucose level, WMSI, Mitral E/A, Tricuspid E/A, MPI) were the independent predictors of abnormal RV function by the combined Echocardiography definition, while (Age, Pain to door, Predilataion, Glucose Level, WMSI) were the independent predictors of abnormal MPI of the RV.