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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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
Keywords
- In-hospital mortality
- Right ventricular dysfunction
- ST segment elevation myocardial infarction
- Percutaneous coronary intervention
- Prognostic factors