Abstract
Background: Right ventricular (RV) involvement portends a worse prognosis in acute myocardial infarction (AMI). Tissue Doppler strain echocardiography (TDSE) allows accurate, sensitive quantitation of RV mechanics. We compared TDSE to echocardiographic wall motion abnormality (WMA) and electrocardiography (EKG) in detecting RV dysfunction in AMI. Methods and Results: We prospectively imaged 55 subjects (40 consecutive patients with AMI and 15 healthy controls). All patients had troponin profiles, coronary angiography, and echocardiography and TDSE. Coronary artery stenosis >70% was considered significant. We excluded 7 AMI with multiple vessel disease. We separated the rest into those with left anterior descending related AMI (LAMI) and right coronary artery related AMI (RAMI). EKG revealed RV AMI in 1 patient. None had RV WMA. RV free wall base and mid-apical segments were analyzed separately. Systolic strain (sS) and systolic (SRs) and early diastolic (SRe) strain rates were lower in RAMI compared to controls with the predominant abnormality in the basal RV with preserved mid-apical mechanics. LAMI mechanics were similar to controls except for lower SRe. Conclusions: TDSE reveals significantly abnormal RV mechanics in RAMI in the absence of WMA or RV related EKG abnormality. TDSE offers a superior alternative to EKG and conventional echocardiography for RV evaluation in AMI.
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