Abstract
Background: An acute myocardial infarction, particularly one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle. Cardiac remodeling after acute myocardial infarction (AMI) is characterized by molecular and cellular mechanisms involving both left and right ventricles. Objective: To study the right ventricular affection in patients with acute myocardial infarction of the left ventricle and treated with primary PCI. Methods: The study was done in the critical care department, Cairo University (in which 2,500 primary percutaneous coronary interventions (PCIs) are done annually). Forty patients with acute ST-elevation myocardial infarction (STEMI) were subjected to primary (PCI), we excluded all patients with RV infarction and patients with pulmonary hypertension. RV function was assessed by first pass radionuclide angiocardiography within 48 hours of admission. Results: Regarding the incidence of right ventricular dysfunction in patients with acute left ventricular STEMI who treated with 1ry PCI, there were 21 patients (52.5%) with RV EF% patients (47.5%) with RV time to peak filling rate (TPFR) > 180 msec. There was a significant relationship between right ventricular dysfunction and duration of ICU stay, impairment of LV systolic function, failure of complete resolution of ST segment elevation, failure of early peaking of cardiac enzymes, occurrence of in-hospital complications and one year mortality. Conclusion: The incidence of right ventricular dysfunction in patients with acute left ventricular STEMI is higher than expected and has a negative impact on their outcome.
Highlights
The LV and RV are working as a “functional syncytium” and the two ventricles cannot be dissociated in an independent manner.Knowledge about the role of the right ventricle in health and disease historically has lagged behind that of the left ventricle.More precise characterization of right ventricular function should improve our understanding of pathophysiology and permit more rational management of cardiac disorders.An acute myocardial infarction, one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle [1].The mechanisms leading to RV dysfunction following AMI involving the LV are not completely clear, but it is frequently assumed that LV failure causes pulmonary hypertension (PH) and increased RV afterload leading to RV remodeling and dysfunction
Regarding the incidence of right ventricular dysfunction in patients with acute left ventricular ST-elevation myocardial infarction (STEMI) who treated with 1ry percutaneous coronary intervention (PCI), there were 21 patients (52.5%) with RV ejection fractions (EFs)% < 40%, 16 patients (40%) with RV peak emptying rate (PER) < 1.9 EDV/s, patients (45%) with RV peak filing rate (PFR) < 2.5 EDV/s and patients (47.5%) with RV time to peak filling rate (TPFR) > 180 msec
Our study included forty patients (32 men and 8 women) aged 54 ± 10 years admitted to ICU with acute STEMI and treated with primary PCI (Table 1 & Table 2), of whom 17 patients (42.5%) were diabetic, 13 patients (57.5%) were hypertensive, 32 patients (80%) were smokers, 23 patients (57.5%) had dyslipidemia, 8 patients (20%) had past history of ischemic heart disease and 16 patients (40%) had family history of ischemic heart disease (Table 3)
Summary
The LV and RV are working as a “functional syncytium” and the two ventricles cannot be dissociated in an independent manner.Knowledge about the role of the right ventricle in health and disease historically has lagged behind that of the left ventricle.More precise characterization of right ventricular function should improve our understanding of pathophysiology and permit more rational management of cardiac disorders.An acute myocardial infarction, one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle [1].The mechanisms leading to RV dysfunction following AMI involving the LV are not completely clear, but it is frequently assumed that LV failure causes pulmonary hypertension (PH) and increased RV afterload leading to RV remodeling and dysfunction. Cardiac remodeling after acute myocardial infarction (AMI) is characterized by molecular and cellular mechanisms involving both left and right ventricles. Objective: To study the right ventricular affection in patients with acute myocardial infarction of the left ventricle and treated with primary PCI. Results: Regarding the incidence of right ventricular dysfunction in patients with acute left ventricular STEMI who treated with 1ry PCI, there were 21 patients (52.5%) with RV EF% < 40%, 16 patients (40%) with RV peak emptying rate (PER) < 1.9 EDV/s, patients (45%) with RV peak filing rate (PFR) < 2.5 EDV/s and patients (47.5%) with RV time to peak filling rate (TPFR) > 180 msec. There was a significant relationship between right ventricular dysfunction and duration of ICU stay, impairment of LV systolic function, failure of complete resolution of ST segment elevation, failure of early peaking of cardiac enzymes, occurrence of in-hospital complications and one year mortality. Conclusion: The incidence of right ventricular dysfunction in patients with acute left ventricular STEMI is higher than expected and has a negative impact on their outcome
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