USEFULNESS OF PULMONARY REGURGITATION TRACINGS AND RIGHT VENTRICULAR
STRAIN IMAGING IN PATIENTS WITH ACUTE INFERIOR WALL MYOCARDIAL
INFARCTION WITH SPECIAL REFERENCE TO RIGHT VENTRICULAR MYOCARDIAL
INFARCTION SUBSET AND IT'S ASSOCIATION WITH IN-HOSPITAL OUTCOME.
Abstract
INTRODUCTION: The patients presenting with inferior wall myocardial
infarction (IWMI) in particular right ventricular myocardial infarction
(RVMI) primarily affects right ventricle (RV) which is poorly evaluated
by echocardiographic tools. AIMS: The objective of this study is to
evaluate the use of various echocardiographic parameters in assessing RV
function in patients with IWMI in particular RVMI subset, correlation
among various echocardiographic parameters amongst them, their
association with in-hospital outcome and the role of intervention by
assessing echocardiographic parameters at 3 month follow-up. The study
specially focuses on pulmonary regurgitation pressure half-time (PRPHT)
and right ventricular global longitudinal strain (RVGLS) as indicators
of RV dysfunction apart from other conventional tools. METHODS: The
study is a prospective observational analysis conducted at public sector
institute in eastern India, involving 155 patients diagnosed with acute
IWMI/RVMI. Patients were categorised into 2 groups based on PRPHT
findings and comparison done among them and overall. Patients underwent
a comprehensive evaluation including echocardiography, and coronary
angiography, followed by a three-month post-treatment follow-up.
Echocardiographic parameters such as left ventricular ejection fraction
(LVEF), PRPHT, tricuspid annular plane systolic excursion (TAPSE), right
ventricular fractional area change (RVFAC), and RVGLS were measured at
both visits. RESULTS: Strong positive correlation were observed between
PRPHT, TAPSE, FAC & RVGLS suggesting their use interchangeably to
assess RV function. The study also explored that PRPHT had moderate
positive correlation with RVGLS. It was also concluded that RVGLS as a
tool is non-inferior to TAPSE and RVFAC in evaluation of RV function. It
was also noted that patients with PRPHT values less than 90, TAPSE of
less than 10, FAC of less than 28% and RVGLS value of less than (-12)
were able to fairly predict in-hospital outcome in patients of
IWMI/RVMI. The findings of present study also suggests that
interventions in IWMI/RVMI has good outcomes at 3 month follow-up.
CONCLUSION: The results indicate that PRPHT could serve as a valuable
prognostic indicator in patients with PRPHT ≤ 100 ms. This study also
suggests that PRPHT has no significant correlation with in-hospital
outcome especially in patients with PRPHT >100ms. It was also
noted that patients with PRPHT values less than 90, TAPSE of less than
10, FAC of less than 28% and RVGLS value of less than (-12) were able
to predict adverse in-hospital outcome in patients of IWMI/RVMI. The
findings of this study also suggest that PRPHT & negated RVGLS are well
correlated with other standard echocardiographic measures of RV
dysfunction viz. TAPSE and FAC. This study also suggests that RVGLS is
non-inferior to TAPSE and FAC in evaluation of RV function in
IWMI/RVMI.The findings also suggests that interventions in IWMI/RVMI has
good outcomes at 3 month follow-up. RVGLS can be used as a tool to
evaluate RV function in such cases.