Assessment of right ventricular function using right ventricular outflow tract-systolic excursion in inferior wall myocardial infarction and angiographic correlation to proximal right coronary artery stenosis

Abstract

Background There are inadequate studies validating the efficacy of several echocardiographic parameters of right ventricular (RV) function in assessing RV infarction and predicting stenosis of proximal right coronary artery (RCA). Most of them evaluated a single parameter and many lacked angiographic correlations.Aim To evaluate RV systolic function using systolic excursion of right ventricular outflow tract (RVOT-SE) by echocardiography with correlation to stenosis of proximal RCA in patients with first incident of acute inferior wall myocardial infarction.Patients and methods Parasternal short-axis view at the level of the aortic valve was obtained using M-mode echocardiography, and RVOT-SE was defined as the RVOT-SE anterior wall. It was measured in 50 patients who underwent CA after acute Inferior ST elevaion myocardial (STEMI).Results Patients with reduced RV function were identified with tricuspid annular plane systolic excursion (TAPSE) below 16 mm. RVOT-SE optimal cutoff values to predict RV systolic dysfunction was SE=5.4 mm with a sensitivity of 91.7% and specificity of 99.97% (area under the curve=0.935, P=0.00). RVOT-SE prediction of proximal RCA stenosis was with a sensitivity of 91.4% and specificity of 90.2%. The study showed significant positive correlations with RV-fractional area change and TAPSE (P=0.00) and significant negative correlations with tissue Doppler myocardial performance index and pulsed wave myocardial performance index (P=0.00).Conclusion RVOT-SE is a naive and precise method for assessing RV systolic function. This study suggested the use of RVOT-SE as a parameter of RV function paired with other indices such as TAPSE.