Echocardiographic Evaluation of Right Ventricular Function in Patients Presenting with Acute ST-Elevation Myocardial Infarction

Abstract

Background: To evaluate the effect of different infarction sites on the right ventricular (RV) function by echocardiography in patients presenting with acute ST-elevation myocardial infarction (STEMI) and to correlate it with in-hospital morbidity and mortality. Materials and Methods: The present study was a descriptive cross-sectional study conducted in a tertiary care hospital involving 55 patients of anterior wall myocardial infarction (AWMI), 25 patients of inferior wall myocardial infarction (IWMI), and 20 patients of IWMI + RVMI. Among them, 55% of patients were males with a M: F ratio of 1.22:1. M-mode, two-dimensional, and Doppler echocardiographic evaluation of both RV and left ventricular (LV) function (tricuspid annular plane systolic excursion/RV fractional area change/right ventricular index of myocardial performance and LV ejection fraction [LVEF]) were done in all patients within 48 h of admission along with the assessment of arrhythmias, heart failure (HF), cardiogenic shock (CS), and complete heart block (CHB). All the four echocardiographic parameters were deranged in 30 (54.5%) patients of AWMI and 14 (70%) patients of IWMI with RVMI. However, derangement in at least one echocardiographic parameter of RV dysfunction was observed in 50 (90.9%) patients of AWMI, 11 (44%) patients of IWMI, and 20 (100%) patients of IWMI+RVMI, respectively. LVEF was significantly reduced in patients with AWMI (40.4 ± 11.2%) as compared to patients with IWMI and IWMI+RVMI, respectively (46.4 ± 10.3% and 46.5 ± 7.6%). Cardiovascular complications (ventricular tachycardia, ventricular fibrillation, atrial fibrillation, CS, and HF) were more in the AWMI patients with RV dysfunction. HF was specifically more in the patients of AWMI (81.8%) than IWMI (28%) and IWMI+RVMI (20%). CHB was frequently seen in IWMI (20%) and IWMI+RVMI (20%) patients. Conclusion: RV dysfunction is not only common in RVMI but also in AWMI and IWMI, and complications of STEMI are also more frequently seen in patients with RV dysfunction.