Right ventricular filling detected by pulsed Doppler echocardiography during the convalescent stage of inferior wall acute myocardial infarction

Abstract

To evaluate right ventricular (RV) diastolic function in patients with inferior wall acute myocardial infarction (AMI), flow velocity patterns of the RV inflow tract were studied in patients with anterior AMI (n = 32), inferior AMI (n = 32) and angina pectoris without left ventricular asynergy (n = 10) using pulsed Doppler echocardiography. Doppler examinations were performed at least 4 weeks after the attack. Twenty-seven healthy persons served as control subjects. Three Doppler variables were measured at the RV inflow tract: the ratio of the late diastolic peak flow velocity due to atrial contraction to the rapid filling peak flow velocity in early diastole ( sol A E ) and the acceleration time and deceleration time of the RV rapid filling wave. sol A E in patients with inferior AMI (1.01 ± 0.24, mean ± standard deviation) was significantly greater than in those with anterior AMI (0.80 ± 0.16, p < 0.001) and angina pectoris (0.79 ± 0.17, p < 0.01) and in normal subjects (0.70 ± 0.17, p < 0.001). sol A E in patients with inferior AMI correlated with the ratio of left ventricular to RV end-diastolic pressure (r = −0.60, p < 0.05). sol A E in inferior AMI with relatively high RV end-diastolic pressure (more than 8 mm Hg, n = 8) was significantly greater than that in those with normal pressure (8 mm Hg or less, n = 9). sol A E in patients with proximal right coronary artery occlusion was significantly greater than that in those with distal occlusion. Deceleration time/√RR in patients with inferior AMI (4.5 ± 1.1) was significantly longer than that in patients with anterior AMI (3.6 ± 1.1, p < 0.01), angina pectoris (3.7 ± 0.5, p < 0.01) and in control subjects (3.5 ± 0.5, p < 0.001). These data indicate that early to mid-RV diastolic filling is impaired in inferior AMI and that pulsed Doppler echocardiography is useful for detecting the RV hemodynamic abnormality of RV filling.