Role of 2-dimensional speckle tracking echocardiography in diagnosis of right ventricular involvement in patients with inferior wall myocardial infarction undergoing primary percutaneous coronary intervention.

Abstract

Diagnosis of right ventricular (RV) infarction in the setting of acute inferior wall myocardial infarction (IWMI) has important prognostic implications. We sought to assess the role of 2-D speckle tracking echocardiography (2-D STE) for the assessment of RV involvement in acute IWMI.We included 100 consecutive patients with a diagnosis of recent IWMI, of which 73 had an RCA culprit lesion, undergoing primary percutaneous coronary intervention (PPCI). Patients (n = 73) were classified into 2 groups based on angiographic evidence of RV involvement (lesions proximal to or involving RV branch versus distal lesions). Echocardiographic features of RV dysfunction were assessed using conventional 2-D echocardiographic, and Tissue Doppler parameters as well as 2-D speckle tracking echocardiography.Out of the 73 patients, 42 had RCA lesion proximal to or involving RV branch, while 31 patients had RCA culprit distal to RV branch. Among different parameters assessing RV function, only RV-FWLS was significantly lower among the former group (- 14.2 ± 4.6 vs. - 17.7 ± 4.2, p = 0.026). Receiver-operator characteristic (ROC) analysis showed that RV-FWLS had the strongest discriminatory capability to identify RV infarction (AUC = 0.7, p = 0.02, 95% CI 0.53-0.78). A cut-off value of RV-FWLS ≤ - 20.5% had 88% sensitivity and 33% specificity for diagnosis of RV infarction.STE-derived RV-FWLS with cutoff ≤ - 20.5% could be a reliable and promising tool for prediction of RV involvement in the setting of acute IWMI, which could guide proper risk stratification and tailored acute management strategy.