Right ventricular involvement in transmural inferior wall infarction: two-dimensional echocardiographic and clinical...

We used two-dimensional echocardiography to assess asynergy in the right (RV) and left (LV) ventricles in 34 selected patients with electrocardiographic evidence of acute transmural inferior myocardial infarction (IMI) 40 +/- 3 (SE) h from the onset of pain. We measured the extent of asynergy, defined as akinesis and/or dyskinesis, for RV and LV in 4 short axis sections and computed asynergy for both ventricles. The incidence of asynergy was 100% in the inferior LV, 76% in the inferior ventricular septum and 76% in the inferior RV. We found a direct correlation between peak creatine phosphokinase levels and LV asynergy (R = 0.71) or (RV + LV) asynergy (R = 0.72). The asynergy and right heart catheterization data correlated with clinical findings in 4 subgroups identified on the basis of hypotension (systolic blood pressure less than 100 mmHg) and pulmonary congestion, (confirmed radiographically): 1A, extensive biventricular asynergy (32% RV, 32% LV) with hypotension and congestion (N = 10); 1B, predominant RV asynergy (49% RV, 26% LV) with hypotension but no congestion (N = 5); 2A, predominant LV asynergy (7% RV, 26% LV) with congestion (N = 10); 2B less extensive biventricular asynergy (15% RV; 16% LV) and uncomplicated IMI (N = 9). Hypotension identified a high risk group (N = 15) prone to complications and death. The extent of RV asynergy was the third strongest discriminator for hypotension, next to systolic blood pressure and jugular venous pressure. The extent of LV asynergy was the strongest discriminator for pulmonary congestion. Among hypotensive patients, the RV/LV asynergy ratio was the strongest discriminator for pulmonary congestion, being significantly greater in those without congestion than in those with congestion (2.2 vs 1.0, P less than 0.001). The increased RV/LV asynergy ratio may be a useful index for predicting predominant RV infarction in IMI.