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Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI

Auswirkungen rechtsventrikulärer diastolischer Dysfunktion auf klinischen Verlauf bei inferiorem STEMI

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Abstract

Background

The aim of this study was to investigate the prognostic value of restrictive right ventricular filling pattern (RRVFP) in patients with the first acute inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) undergoing primary percutaneous coronary intervention (p-PCI).

Method

A total of 152 patients with acute IWMI complicated by RVMI undergoing p‑PCI were divided into two groups according to the presence of RRVFP. RRVFP was defined as tricuspid diastolic early/late flow velocities (Et/At) > 2 and Et deceleration time (DT) < 120 ms.

Results

There were 23 patients with RRVFP in the study cohort. At, DTt, isovolumetric relaxation time (IVRT), and tissue Doppler tricuspid annular late velocity (A′t) were reduced significantly in patients with RRVFP than in those without RRVFP (At 19.6 ± 2.7 vs. 39.1 ± 7.4 cm/s, p < 0.001; DTt 106 ± 13 vs.156 ± 21 ms, p = 0.001; IVRT 59 ± 6.7 vs. 62 ± 7.4 ms, p = 0.01; A′t 4.6 ± 1.1 vs. 8.6 ± 1.05, p = 0.001). Et/At ratios were higher in patients with RRVFP than in those without RRVFP (Et/At 2.20 ± 0.2 vs. 1.15 ± 0.37, p < 0.001). Et, tissue Doppler tricuspid annular early velocity (E’t), E′t/A′t ratio, and Et/E′t ratio were not significantly different between groups (Et 43.3 ± 5.4 vs. 40.7 ± 9.2 cm/s p = 0.18; E′t 8.8 ± 1.4 vs. 9.5 ± 2.3, p = 0.15; E′t/A′t 1.08 ± 0.24 vs. 1.13 ± 0.30, p = 0.52; Et/E′t ratio 5.0 ± 1.1 vs. 4.5 ± 1.5 p = 0.09). Presence of E′t/A′t > 2, short DTt, RRVFP, unsuccessful p‑PCI, and cardiogenic shock on admission were independent predictors of in-hospital mortality (p < 0.05) in multivariable logistic regression analysis.

Conclusion

Presence of RRVFP is associated with in-hospital mortality in patients presenting with their first IWMI complicated by RVMI.

Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, den prognostischen Wert eines restriktiven rechtsventrikulären Füllungsmusters (RRVFP) bei Patienten mit erstmaligem akutem Myokardinfarkt der inferioren Wand (IWMI) und der Komplikation eines rechtsventrikulären Myokardinfarkts (RVMI) sowie primärer perkutaner Koronarintervention (p-PCI) zu untersuchen.

Methoden

Insgesamt 152 Patienten mit akutem IWMI und RVMI als Komplikation, bei denen eine p‑PCI erfolgte, wurden je nach Vorliegen eines RRVFP in 2 Gruppen aufgeteilt. Ein RRVFP war definiert als trikuspide früh-/spätdiastolische Flussgeschwindigkeit (Et/At) > 2 und Et-Dezelerationszeit (DT) < 120 ms.

Ergebnisse

Die Studienkohorte enthielt 23 Patienten mit RRVFP. At, trikuspide E‑Wellen-Dezelerationszeit (DTt), isovolumetrische Relaxationszeit (IVRT) und späte Gewebsdopplergeschwindigkeit am Trikuspidalklappenring (A′t) waren bei Patienten mit RRVFP signifikant geringer als bei Patienten ohne RRVFP (At: 19,6 ± 2,7 vs. 39,1 ± 7,4 cm/s; p < 0,001; DTt: 106 ± 13 vs.156 ± 21 ms; p = 0,001; IVRT: 59 ± 6,7 vs. 62 ± 7,4 ms; p = 0,01; A′t: 4,6 ± 1,1 vs. 8,6 ± 1,05; p = 0,001). Der Et/At-Quotient war bei Patienten mit RRVFP höher als bei jenen ohne (Et/At: 2,20 ± 0,2 vs. 1,15 ± 0,37; p < 0,001). Et, frühe Gewebsdopplergeschwindigkeit am Trikuspidalklappenring (E’t), E′t/A′t-Quotient und Et/E′t-Quotient unterschieden sich zwischen den beiden Gruppen nicht signifikant (Et: 43,3 ± 5,4 vs. 40,7 ± 9,2 cm/s; p = 0,18; E′t: 8,8 ± 1,4 vs. 9,5 ± 2,3; p = 0,15; E′t/A′t: 1,08 ± 0,24 vs. 1,13 ± 0,30; p = 0,52; Et/E′t-Quotient: 5,0 ± 1,1 vs. 4,5 ± 1,5; p = 0,09). Vorliegen eines E′t/A′t > 2, kurze DTt, RRVFP, erfolglose p‑PCI und kardiogener Schock bei Aufnahme waren unabhängige Prädiktoren der Krankenhausmortalität (p < 0,05) in der multivariablen logistischen Regressionsanalyse.

Schlussfolgerung

Das Vorliegen eines RRVFP ist mit der Krankenhausmortalität bei Patienten assoziiert, die sich erstmals wegen eines IWMI mit der Komplikation eines RVMI vorstellen.

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References

  1. Goldstein JA (2002) Pathophysiology and management of right heart ischemia. J Am Coll Cardiol 40:841

    Article  Google Scholar 

  2. Foussas SG, Zairis MN, Tsiaousis GZ et al (2010) The impact of right ventricular involvement on the postdischarge long-term mortality in patients with acute inferior ST-segment elevation myocardial infarction. Angiology 61:179–183

    Article  Google Scholar 

  3. Mehta SR, Eikelboom JW, Natarajan MK et al (2001) Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 37:37–43

    Article  CAS  Google Scholar 

  4. Assali AR, Teplitsky I, Ben-Dor I et al (2007) Prognostic importance of right ventricular infarction in an acute myocardial infarction cohort referred for contemporary percutaneous reperfusion therapy. Am Heart J 153:231–237

    Article  Google Scholar 

  5. Kakouros N, Cokkinos DV (2010) Right ventricular myocardial infarction: pathopyhsiology, diagnosis and management. Postgrad Med J 86:719–728

    Article  Google Scholar 

  6. Fujii J, Yazaki Y, Sawada H et al (1985) Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two-dimensional doppler echocardiographic method. J Am Coll Cardiol 5:1155–1160

    Article  CAS  Google Scholar 

  7. Nijland F, Kamp O, Karreman AJ, al el (1997) Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial doppler echocardiographic study. J Am Coll Cardiol 30:1618–1624

    Article  CAS  Google Scholar 

  8. Oh JK, Ding ZP, Gersh BJ et al (1992) Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction. J Am Soc Echocardiogr 5:497–503

    Article  CAS  Google Scholar 

  9. Cerisano G, Bolognese L, Buonamici P et al (2001) Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction. J Am Coll Cardiol 37:793–799

    Article  CAS  Google Scholar 

  10. Kolh P, Wijns W (2011) Joint esc/eacts guidelines on myocardial revascularization. J Cardiovasc Med (Hagerstown) 12:264–267

    Article  Google Scholar 

  11. Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: A report from the american society of echocardiography endorsed by the european association of echocardiography, a registered branch of the european society of cardiology, and the canadian society of echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 786–688)

    Article  Google Scholar 

  12. Sutherland GR, Di Salvo G, Claus P et al (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17(7):788-802

  13. Jacobs AK, Leopold JA, Bates E et al (2003) Cardiogenic shock caused by rightventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol 41:1273–1279

    Article  Google Scholar 

  14. Hamon M, Agostini D, Le Page O et al (2008) Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: meta-analysis. Crit Care Med 36:2023–2033

    Article  Google Scholar 

  15. Rallidis LS, Makavos G, Nihoyannopoulos P (2014) Right ventricular involvement in coronary artery disease: role of echocardiography for diagnosis and prognosis. J Am Soc Echocardiogr 27:223–229

    Article  Google Scholar 

  16. Kakouros N, Kakouros S, Lekakis J et al (2011) Tissue Doppler imaging of the tricuspid annulus and myocardial performance index in the evaluation of right ventricular involvement in the acute and late phase of a first inferior myocardial infarction. Echocardiography 28:311–319

    Article  Google Scholar 

  17. Ozdemir K, Altunkeser B, Icli A et al (2003) New parameters in identificationof right ventricular myocardial infarction and proximal right coronary artery lesion. Chest 124:219–226

    Article  Google Scholar 

  18. Dokainish H, Abbey H, Gin K et al (2005) Usefulness of tissue Doppler imaging in the diagnosis and prognosis of acute right ventricular infarction with inferior wall acute left ventricular infarction. Am J Cardiol 95:1039–1042

    Article  Google Scholar 

  19. Kidawa M, Chizynski K, Zielinska M et al (2013) Real-time 3D echocardiography and tissue Doppler echocardiography in the assessment of right ventricle systolic function in patients with right ventricular myocardial infarction. Eur Heart J Cardiovasc Imaging 14:1002–1009

    Article  Google Scholar 

  20. Mukhaini M, Prashanth P, Abdulrehman S et al (2010) Assesment of right ventricular diastolic function by tissue doppler imaging in patients with acute right ventricular myocardial infarction. Echocardiography 27:539–543

    Article  Google Scholar 

  21. Cerisano G, Bolognese L, Carrabba N et al (1999) Doppler-derived mitral deceleration time: an early strong predictor of left ventricular remodeling after reperfused anterior acute myocardial infarction. Circulation 99:230–236

    Article  CAS  Google Scholar 

  22. Yoshifuku S, Otsuji Y, Takasaki K et al (2003) Pseudonormalized Doppler total ejection isovolume (Tei) index in patients with right ventricular acute myocardial infarction. Am J Cardiol 91:527–531

    Article  Google Scholar 

  23. Brodie BR, Stuckey TD, Hansen C et al (2007) Comparision of late survival in patients cardiogenic shock due to right ventricular infarction versus left ventricular pump failure following primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am J Cardiol 99:431–435

    Article  Google Scholar 

  24. Brookes C, Ravn H, White P et al (1999) Acute right ventricular dilatation in response to ischemia significantly impairs left ventricular systolic performance. Circulation 100:761–767

    Article  CAS  Google Scholar 

  25. Mikell FL, Asinger RW, Hodges M (1983) Functional consequences of interventricular septal involvement in right ventricular infarction: echocardiographic, clinical, and hemodynamic observations. Am Heart 105:393–401

    Article  CAS  Google Scholar 

  26. Fixler DE, Monroe GA, Wheeler JM (1977) Hemodynamic alterations during septal or right ventricular ischemia in dogs. Am Heart J 93:210–215

    Article  CAS  Google Scholar 

  27. Goldstein JA, Tweddell JS, Barzilai B et al (1992) Importance of left ventricular function and systolic ventricular interaction to right ventricular performance during acute right heart ischemia. J Am Coll Cardiol 19:704–711

    Article  CAS  Google Scholar 

  28. Lazar EJ, Goldberger J, Peled H et al (1988) Atrial infarction: diagnosis and management. Am Heart J 116:1058–1063

    Article  CAS  Google Scholar 

  29. Goldstein JA, Tweddell JS, Barzilai B et al (1991) Right atrial ischemia exacerbates hemodynamic compromise associated with experimental right ventricular dysfunction. Am J Collcardiol 18:1564–1572

    Article  CAS  Google Scholar 

  30. Vargas-Barron J, Romero-Cardenas A, Espinola-Zavaleta N et al (1998) Transesophageal echocardiographic study of the right atrial myocardial infarction and myocardial viability. Echocardiography 15:201–209

    Article  Google Scholar 

  31. Vargas-Barron J, López-Meneses M, Roldán FJ et al (2002) The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: Transesophageal echocardiographic examination. Clin Cardiol 25:181–186

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Cardiology, Diyabakır Gazi Yaşargil Research and Education Hospital, Peyas Mahallesi, Selahaddin Eyubbi Bulvarı, 229. Sokak Hamzaoğulları Sitesi B/20 Kayapınar, 21070, Diyarbakır, Turkey

    B. Altıntaş MD, R. Altındağ MD, E. Baysal MD, Ö. Bilge MD, H. Çiftçi MD, M. Ş. Adıyaman MD, M. Z. Karahan MD, İ. Kaya MD & K. Çevik MD

  2. Department Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey

    B. Yaylak MD

  3. Department of Cardiology, Bozok University School of Medicine, Yozgat, Turkey

    H. Ede MD

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  1. B. Altıntaş MD
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Correspondence to B. Altıntaş MD.

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Conflict of interest

B. Altıntaş, B. HYaylak. Ede, R. Altındağ, E. Baysal, Ö. Bilge, H. Çiftçi, M. Ş. Adıyaman, M.Z. Karahan, İ. Kaya, and K. Çevik declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Altıntaş, B., Yaylak, B., Ede, H. et al. Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI. Herz 44, 155–160 (2019). https://doi.org/10.1007/s00059-017-4631-9

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  • DOI: https://doi.org/10.1007/s00059-017-4631-9

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