ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT VENTRICULAR FUNCTION IN INFERIOR WALL MYOCARDIAL INFARCTION AND ANGIOGRAPHIC CORRELATION WITH RIGHT CORONARY ARTERY STENOSIS

SUNIL MISHRA; GOURAV BHATTACHARYA; PRAMOD KUMAR; UTTAM KUMAR PATNAIK

Volume : IX, Issue : V, May - 2020

ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT VENTRICULAR FUNCTION IN INFERIOR WALL MYOCARDIAL INFARCTION AND ANGIOGRAPHIC CORRELATION WITH RIGHT CORONARY ARTERY STENOSIS

Sunil Mishra, Gourav Bhattacharya, Pramod Kumar, Uttam Kumar Patnaik

Abstract :

Presence of Right Ventricular MI (RVMI) imposes an increased risk of shock, arrhythmia and death in inferior wall MI (IWMI) and is caused by occlusion of proximal dominant Right Coronary Artery (RCA). It is important to identify the culprit artery for risk stratification and optimizing treatment strategies. However ECG often proves inadequate to predict proximal RCA as infarct related artery. Our study is an attempt to assess various parameters of RV function and to correlate them with a RCA lesion in coronary angiogram. The study population comprised of 70 patients admitted to coronary care unit in our hospital in a span of 1 year with first episode of acute IWMI presenting within 24 hours of symptom onset. RV functional assessment like TAPSE (Tricuspid Annular Plane Systolic Excursion), S� (tissue doppler systolic annular velocity), MPI (Myocardial Performance Index), RVFAC (Right Ventricle Fractional Area Change) were done. According to angiographic findings, the patients were divided into Group A with proximal RCA stenosis and Group B with distal RCA stenosis. RV function was significantly poorer in proximal RCA stenosis as evidenced by lower TAPSE, S�, RVFAC and higher MPI compared to distal RCA stenosis. These are easy to perform and useful in predicting proximal RCA as infarct related artery. Out of these, after multiple regression analysis, TAPSE ≤16mm was the most specific (99%) parameter followed by RVFAC <35% (96%). MPI–PW≥ 0.7 was the most sensitive (93%) tool in predicting proximal RCA stenosis. All patients with proximal RCA stenosis had RV Dysfunction as assessed by echocardiography but the incidence of RVMI by ECG was 69% in patients of proximal RCA stenosis.