Gourav Bhattacharya
Sriram Chandra Bhanj Medical College, Odisha, India
Title: ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT VENTRICULAR FUNCTION IN INFERIOR WALL MYOCARDIAL INFARCTION AND ANGIOGRAPHIC CORRELATION WITH RIGHT CORONARY ARTERY STENOSIS
Biography
Biography: Gourav Bhattacharya
Abstract
Presence of Right Ventricular MI (RVMI) imposes an increased risk of shock, arrhythmia and death (16% vs 3.5%) in inferior wall MI (IWMI). Occlusion of proximal dominant Right Coronary Artery (RCA) is usually responsible for RVMI in IWMI (RR- 3.0). It is important to identify the culprit artery for risk stratification and optimizing treatment strategies for patients with acute IWMI. ECG often proves inadequate to predict proximal RCA as infarct related artery. The study population comprised of 92 patients admitted to coronary care unit of the Dept of Cardiology, SCBMCH, Cuttack from Nov 2017 to Oct 2018 with first episode of acute IWMI presenting within 24 hours of symptom onset. 70 patients were selected from them after applying the inclusion and exclusion criteria. Detailed clinical examination, routine blood tests, ECG and 2DEcho was done. RV function assessment like TAPSE (Tricuspid Annular Plane Systolic Excursion), S’ (tissue doppler systolic annular velocity), MPI PW (Myocardial Performance Index by Pulsw Wave doppler), RVFAC (Right Ventricle Fractional Area Change) were done. Multiple regression analysis was performed including parameters of RV function (TAPSE, S’, MPI) to explore the parameters most useful for the prediction of proximal RCA ischemia. Receiver operator characteristic curve was constructed for the most independent predictors for proximal RCA lesions. Youdon’s equation was used to determine the best cut-off value for the useful parameters to give equal weight to sensitivity and specificity. Echocardiographic assessment of various parameters of RV function showed significant difference between groups with proximal RCA and distal RCA lesion in patients of IWMI. S’, MPI and TAPSE are easy to perform and useful in predicting proximal RCA as infarct related artery. Out of these, TAPSE ≤16mm was the most specific (99%) parameter followed by RVFAC <35% (96%). MPI-PW≥ 0.7 was the most sensitive (93%) tool in predicting proximal RCA stenosis. All patients with proximal RCA stenosis had RV Dysfunction as assessed by echocardiography. The incidence of RVMI was 69% in patients of proximal RCA stenosis.