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[Prognostically significant right ventricular echocardiographic parameters for one-year outcomes of inferior wall
1Kazan (Volga Region) Federal University.
Aim:
To establish prognostically significant for one-year outcomes of left ventricular inferior wall myocardial infarction echocardiographic indicators of right ventricular involvement.
Materials And Methods:
Multivariate mathematical analysis of 184 parameters, including 131 echocardiographic ones, of 144 patients with myocardial infarction of the inferior wall of the left ventricle was performed.
Results:
Before percutaneous coronary intervention, signs of right ventricular infarction on ECG (ST elevation in V3R-V4R leads) were present in 45.8% of patients. On the 5th-7th day of myocardial infarction the values of echocardiographic parameters between the groups with and without right ventricular infarction did not differ significantly. Among patients with biventricular infarction in 40.9% of cases hypokinesis of the basal inferior segment of the right ventricle was visualized, in 9.1% - dilatation of the right ventricle, a large zone of local contractility impairment and global systolic dysfunction of both ventricles. The prognostic significance for unfavorable posthospital outcomes of inferior wall myocardial infarction was stenting of more than one coronary artery, decreased global circular deformation and visualization of more than four segments with impaired local contractility of the left ventricle (AUC 81.4%, sensitivity 69%, specificity 83%). Such unfavorable outcomes as recurrent myocardial infarction and necessity of aortocoronary bypass surgery are predicted by: hypokinesis of LV on echocardiography, ECG signs of right ventricular infarction, end-systolic volume index and left ventricular ejection fraction (AUC 71.9%, sensitivity 62%, specificity 70%).
Conclusion:
Among echocardiographic signs of right ventricular involvement, hypokinesis of the basal inferior segment of the right ventricle was determined to be prognostically significant for one-year outcomes of inferior wall myocardial infarction of the left ventricle. Hypokinesis of the basal inferior segment of the right ventricle was visualized in 40.9% of patients with biventricular (according to ECG) inferior wall infarction, including 9.5% with extensive right ventricular infarction and right ventricular dilatation.
