Abstract
Background: The right atrium (RA), has received the least attention by researchers. Many reports demonstrated that, RA function may be impaired in the early stages of cardiac disease. The RA plays an important role in maintaining right ventricular (RV) output. RA functional changes have been evaluated in patients with coronary artery disease, but RA affection is not fully elucidated in patients with myocardial infarction (MI) Objective: To assess RA function by 2-Dimensional speckle tracking echocardiography (2D-STE) imaging in patients with acute first left ventricular (LV) inferior wall MI with and without RV involvement. Patients & methods:-Sixty patients with acute first inferior MI were included in this study; 30 patients had ECG signs of inferior MI without RV infarction (group II) and 30 patients had ECG signs of inferior MI with RV involvement (group III). Twenty five age and sex -matched healthy volunteers were included as a control group (group I). Assessment of RA function was done in all subjects using (2D-STE) for measurements of RA septal and free walls longitudinal strain and strain rate (SR). Results:-RA septal wall & global systolic strain were significantly reduced in group III (22.5±14.8% and 40.4±24.5%) compared to group I (37.5±16.3% and 60.4±22.4%) and group II (35.7±17.4% and 54.9±25.73%), (P<0.001), (P=0.008) respectively. RA septal wall and global early diastolic strain rate were also significantly reduced in group III (- 0.77±0.46 s-1 and – 3.61±0.55 s-1) compared to group I (-1.38±0.74 s-1 and – 4.41±0.67 s-1) and group II (-1.07±0.76 s-1 and -3.73±0.76 s-1), (P=0.005), (P<0.001) respectively. Conclusion:-In patients with first LV inferior wall MI with RV involvement, RA functional parameters (RA septal and global strain and SR) were significantly impaired in comparison to healthy controls and patients with first LV inferior wall MI without RV affection. This result may illustrate the significant relation between RV & RA which is still under research.
Highlights
Myocardial infarction (MI) is a major cause of death and disability worldwide
A few studies showed that strain and strain rate imaging appears good for functional assessment of the right atrium. the accuracy of strain rate imaging to quantify RA deformation that can be occur as a complication of inferior STEMI specialy if associated with right ventricular (RV) affection
In Nourian et al study that assessed RA reservoir, conduit & contractile functions in 70 patients with inferior myocardial infarction (MI) (43 patients without RVMI & 27 patients with RVMI) shows that the 2D speckle tracking echocardiography (2DSTE) for the evaluation of RA function showed that RA SRe, and RA strain rate (SR) were lower in the patients with INFMI + RVMI than in the patients
Summary
Myocardial infarction (MI) is a major cause of death and disability worldwide. Coronary atherosclerosis is achronic disease with stable and unstable periods. RA function changes have been evaluated in patients with coronary artery disease, but RA function in patients with myocardial infarction (MI) has yet to be fully elucidated. The RA interacts with the RV with altered RV systolic and diastolic function with an increased filling pressure It can, be anticipated that some changes may occur in RA function. Strain & strain rate techniques are used to assess myocardial movement and deformation. These methods have been frequently used to assess LV function; they have yet rarely been used to examine RA function [9], despite RA function is an important prognostic factor in patients with acute first inferior MI [3]
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