Right Ventricular Function Suffers From Reperfusion Delay: Tissue Doppler Study

Abstract

In this study, impact of reperfusion delay on adverse cardiac events and right ventricular (RV) function in patients with acute right ventricular myocardial infarction (RVMI) was assessed. In 70 patients with RVMI, RV function was assessed by M-mode tricuspid annular plane systolic excursion (TAPSE) and by pulsed wave tissue Doppler echocardiography (TDE). Right ventricular early (E'(T)) and late diastolic (A'(T)), peak systolic tricuspid annular velocity, (S'(T)) and right ventricular myocardial performance index (RVMPI) were measured. Patients were divided into 2 groups according to the time between the onset of symptoms and percutaneous transluminal coronary angioplasty (PTCA)-group 1 (n = 25), < or =3 hours and group 2 (n = 45), > 3 hours. During 30-day follow-up, we assessed adverse cardiac events like the following: death, cardiogenic shock, need for intra-aortic counterpulsation, temporary transvenous pacing support (PCM), presence of ventricular septal defect (VSD), cardiac tamponade, or free wall rupture. Group 1 had significantly higher values of E'(T), S'(T), and TAPSE than group 2. RVMPI was significantly elevated in group 2. A total of 13 (18.2%) patients had a cardiac event, 5 patients (7.1%) died. We observed an increase of cardiac events in patients with reperfusion delayed more than 3 hours (P = .056). TAPSE-derived and TDE-derived right ventricular systolic and early diastolic velocities were less affected in patients with shorter time from pain onset to opening of the occluded right coronary artery (RCA). Presented initial data show that the tissue Doppler technique may be useful for identification of patients with RV infarction with higher rate of adverse cardiac events including death.