Right ventricular function in coronary artery disease as assessed by two-dimensional echocardiography
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Two-dimensional echocardiography detected right ventricular regional wall motion abnormalities in 22% of patients with inferior myocardial infarction, identifying significant right ventricular dysfunction. Hyperdynamic right ventricular function was observed in 80% of patients with acute anterior myocardial infarction.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Coronary artery disease (CAD) can affect right ventricular (RV) function.
- Assessing RV involvement in myocardial infarction (MI) is crucial for patient management.
- Two-dimensional echocardiography (2DE) is a widely used imaging modality.
Purpose of the Study:
- To evaluate the utility of 2DE in detecting regional wall motion abnormalities (RWMA) of the RV in patients with CAD.
- To correlate RV RWMA with clinical findings and RV ejection fraction (RVEF).
- To assess RV function in acute anterior MI (AMI) and inferior MI (IMI).
Main Methods:
- 2DE was performed in 64 patients with CAD (46 men, 18 women, aged 58.7 +/- 11.4 years).
- Standard echocardiographic views were obtained, focusing on the RV free and diaphragmatic walls.
- Correlation with clinical data and RVEF (measured by first-pass radionuclide angiography) was performed.
Main Results:
- RV RWMA were detected in 22% of patients with acute IMI and 21% with old IMI.
- Patients with RV RWMA often presented with hypotension, conduction blocks, or arrhythmias.
- RVEF was significantly lower in IMI patients with RV RWMA (19.7 +/- 8.3%) compared to those without (35.3 +/- 9.6%).
- Hyperdynamic RV wall motion was observed in 80% of patients with AMI.
- No RV RWMA was seen in patients with significant right coronary artery obstruction without infarction.
Conclusions:
- 2DE can detect RV RWMA in patients with IMI, indicating clinically significant RV dysfunction.
- RV infarction is a likely cause of RV RWMA in IMI.
- Compensatory hyperdynamic RV function is common in AMI.
- 2DE is valuable for assessing RV involvement in CAD and MI.
Abstract:
Two-dimensional echocardiography (2DE) was performed in 64 patients with coronary artery disease. There were 46 men and 18 women, aged 58.7 +/- 11.4 years. An apical four-chamber view, a two-chamber right ventricular (RV) view, and a subcostal four-chamber view were obtained in 58 of 64 (91%) patients. Regional wall motion abnormalities ( RWMA ) of the RV free or diaphragmatic wall were detected in 4 of 18 (22%) patients with acute inferior myocardial infarction (IMI) and in 3 of 14 (21%) patients with old IMI. All seven patients with RWMA by 2DE had two or more of the following findings: hypotension, second- or third-degree atrioventricular block, atrial arrhythmias, or ventricular tachycardia. The RV ejection fraction by first-pass radionuclide angiography was 19.7 +/- 8.3% in patients with IMI and RV RWMA by 2DE compared to 35.3 +/- 9.6% (p less than 0.005) in patients without. A hyperdynamic RV wall motion was seen in 12 of 15 (80%) patients with acute anterior MI (AMI). No RV RWMA was observed in 17 patients with greater than 75% obstruction of right coronary artery and absent infarction. Thus, RWMA of the right ventricle were detected by 2DE in 22% of patients with IMI and identified patients with clinically significant RV dysfunction, probably due to RV infarction; a compensatory hyperdynamic RV wall motion was observed in 80% of patients with acute AMI.