AN ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT VENTRICULAR FUNCTION IN INFERIOR WALL MYOCARDIAL INFARCTION UNDERGOING PRIMARY PTCA VS. PTCA WITHIN ONE MONTH OF INDEX EVENT- A FOLLOW-UP STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 34
Abstract
BACKGROUND Risk of shock, arrhythmia and death due to Inferior Wall Myocardial Infarction (IWMI) is higher in the presence of Right Ventricular Myocardial Infarction (RVMI). RVMI along with IWMI (relative risk 3.0) usually results from occlusion of dominant Right Coronary Artery (RCA). Electrocardiogram (ECG) frequently fails to predict proximal RCA as infarct related artery. ECG changes are brief and disappear within 10 hours in 48% of cases. Therefore, its utility reduces in cases of late presentations. There is lack of literature validating usefulness of various echocardiographic parameters in assessing RV function after successful revascularisation procedures in patients presenting with acute IWMI. Aim: This research intends to assess right ventricle function by Tricuspid Annular Plane Systolic Excursion (TAPSE) and MPI by pulsed TDI in patients with acute IWMI after primary PTCA at discharge, 3 months and 6 months. MATERIALS AND METHODS This prospective cohort study was undertaken in the coronary care unit of the Dept. of Cardiology, Kasturba Medical College, Mangalore from September 2015 to October 2016 with first episode of acute inferior wall myocardial infarction and within one month of index event. RESULTS Our study group comprised of 84 patients, 60 (71.4%) males and 24 (28.6%) females. Predominantly, males were noted in the age group between 61-70 years (35.7%) and females in the age group between 51-60 years (28.6%). Mean age in Group 1 was 62.4±9.34 years and in Group 2 was 58±11.8 years 54 (64.3%). In our study, mean TAPSE measurement was significantly lower at the time of discharge in individuals with first episode of acute IWMI (14.98±1.33). CONCLUSION The results of this study indicate that acute IWMI affecting the right ventricle seriously impairs RV systolic function with significant improvement at 3 months and 6 months follow-up after the acute event with successful revascularisation. Echocardiographic assessment of RV function (MPI and TAPSE) showed a significant difference between groups with acute IWMI and recent IWMI. In IWMI patients, significant increase in TAPSE values were observed post reperfusion. Reperfusion therapy, especially primary PCI restores the RV systolic function more rapidly in patients with acute IWMI. Reperfusion therapy in patients presenting within one month of index event also restore the right ventricular systolic function, particularly in those who received thrombolysis.
Authors and Affiliations
Narasimha Pai D, Yogesh Kharche, Syed Waleem Pasha, K. Padmanabha Kamath, R. L. Kamath, Chaithra Nayak, Francis N. P. Monteiro
Keywords
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- EP ID EP544753
- DOI 10.14260/jemds/2018/848
- Views 66
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