MEHMET ATA AKIL, Faruk ERTAŞ, Hasan KAYA, MEHMET ZİHNİ BİLİK, Mustafa OYLUMLU, Abdulkadir YILDIZ, Kenan İLTÜMÜR, Mehmet Sıddık ÜLGEN

ST elevasyonlu miyokard infarktüsünde infarkt lokalizasyonuna göre sağ ventrikül fonksiyonlarının ileri ekokardiografik metotlarla karşılaştırılması

Amaç: Bu çalışmada amacımız ST elevasyonlu miyokard infarktüsü (STEMİ) hastalarında ileri ekokardiyografik metodlar kullanarak infarkt lokalizasyonunun sağ ventrikül fonksiyonları üzerindeki etkilerini karşılaştırmaktır. Gereç ve yöntem: Çalışmaya toplam 89 STEMİ hastası alındı. Hastalar infarkt lokalizasyonuna göre anteriyor, izole inferior ve inferior+sağ ventrikül miyokard infarktüsü (Mİ) olmak üzere üç gruba ayrıldı. Tüm hastalara ilk 24- 72 saat içinde ekokardiografik inceleme yapılarak rutin ekokardiografik ölçümlere ek olarak sağ ventrikül doku Doppler, sağ ventrikül ejeksiyon fraksiyonu (SağVEF), miyokard performans indeksi (MPİ) ve Triküspit Anüler Düzlem Sistolik Hareketlerinin (TAPSE) ölçümleri alındı. Bulgular: Gruplar karşılaştırıldığında, sağ ventrikül tutulumu olan inferior Mİ grubunda sağ ventrikül fonksiyonlarının bozulmuş olduğu görüldü. TAPSE, sağ ventrikül tutulumu olan inferior MI (19±1mm) grubunda izole inferior MI (23±1mm) ve anterior MI (23±1mm) gruplarına göre daha düşüktü (p

Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation

Objectives: In this study, we aimed to compare the ef- fects of infarct localization in patients with ST Elevated Myocardial Infarction (STEMI) on the right ventricular (RV) functions by using advanced echocardiographic methods. Materials and methods: A total of 89 patients with STEMI were included into the study and patients were divided to three groups as anterior, isolated-inferior and inferior+RV MI groups. In addition to standard echocardiographic mesurements, RV tissue doppler, RV Ejection Fraction (RVEF), Myocardial performance index (MPI) and TAPSE measurements of all patients were performed between 24-72 hours after the event. Results: Compared to groups, RV functions in inferior MI with RV involvement group were deteriorated. Tricuspid annular plane systolic excursion (TAPSE) value for the inferior MI with RV involvement (19±1mm) group were lower than those for Inferior MI group without RV involvement (23±1mm) and anterior MI (23±1mm) (p<0.05). The RV MPI value for inferior MI group with RV involvement (0.76±0.14) were found to be higher than those for anterior (0.64±0.1) and inferior MI (0.56±0.1) group without RV involvement (p<0.05). Peak Sm (r = -0.35, p = 0.01), TAPSE (r = -0.47, p<0.001) and RV EF (r = -0.46, p<0.001) showed a negative correlation with RV MPI val- ue. Furthermore, RV tricuspid E/A rate (r = -0.19, p = 0.7) and RV free wall tissue doppler Em/Am rate (r = -0.26, p = 0.01) displayed a negative correlation with RV MPI value. Conclusions: Use of advanced methods addition to the conventional echocardiographic methods in STEMI patients, could produce more valuable information to evalu-ate RV functions and provide a positive impact on treatment strategies.

PDF

___

1. Gaudron P, Eilles C, Kugler I, et al. Progressive left ventricu- lar dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation 1993;87(3):755-63.
2. Fixler DE, Monroe GA, Wheeler JM. Hemodynamic alterations during septal or right ventricular ischemia in dogs. Am Heart J 1977;93(2):210-5.
3. Zornoff LA, Skali H, Pfeffer MA, et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol 2002;39(9):1450- 5.
4. Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums Echo- cardiography. 6th edition. Philadelphia: Lippincott Williams & Wilkins; 2005:202-3.
5. Fast Facts- Hyperlipidaemia 2001 Paul Durrington, Allan Sniderman 1. Baskısının Türkçesi. Editör: Uzm Dr. Arif Nihat Dursun; Çeviri; Dr. Bülent Genç. And Danışmanlık Eğitim Yayıncılık ve Organizasyon Ltd. Şti. Sayfa 18-28.
6. Ross R. The pathogenesis of atherosclerosis: A perspective for the 1990s. Nature 1993;362(6423):801-9.
7. Ross R, Glomset JA. The pathogenesis of atherosclerosis. N Eng J Med 1976;295(7):369-77.
8. Ross R. Atherosclerotic Coronary Heart Disease “The Heart”. Swenth Ed, Edi J.W. Hurst, PP: Mc Graw-Hill Company, New York 1990. 877-892
9. Allen HD et al ACC/AHA guidelines for cardiac catheterization labaratories circulation 2004; 93(5):2213-47.
10. Dell’Italia LJ, Starling MR, Crawford MH, et al. Right ventricular infarction: identification by hemodynamic measurements before and after volume loading and correlation with noninvasive techniques. J Am Coll Cardiol 1984;4(5):931-9.
11. Chockalingam A, Gnanavelu G, Alagesan R. Myocardial performance index in evaluation of acute right ventricular myocardial infarction. Echocardiography 2004;21(6):587-94.
12. Kaul S, Tei C, Hopkins JM, et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984;107:526-31.
13. Ghio S, Recusani F, Klersy C, et al. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol 2000;85(7):837-42.
14. Ueti OM, Camargo EE, Ueti AA, et al. Assessment of right ventricular function with Doppler echocardiographic in- dices derived from tricuspid annular motion: comparison with radionuclide angiography: Heart 2002;88(3):244-8.
15. Alam M, Wardell J, Andersson E, et al. Right ventricular function in patients with first inferior myocardial infarction: assessment by tricuspid annular motion and tricuspid annular velocity. Am Heart J 2000;139(4):710-5.
16. Ozdemir K, Altunkeser BB, Icli A, et al. New parameters in identification of right ventricular myocardial infarc- tion and proximal right coronary artery lesion. Chest 2003;124(1):219-26.
17. Dell’ltalia IJ, Starling MR. Right ventricular infarction: an important clinical entity. Curr Probl Cardiol 1984;9(1):1-72.
18. Lax JA, Bermann AM, Cianciulli TF, et al. Estimation of the ejection fraction in patients with myocardial infarction obtained from the combined index of systolic and diastolic left ventricular function: a new method. J Am Soc Echocardiogr 2000;13(2):116-23.
19. Tei C, Dujardin KS, Hodge DO, et al. Doppler echocar- diographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996;9(5):838-47.
20. Eidem BW, O’Leary PW, Tei C, et al. Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiol 2000; 86(2):654-8.
21. Moller JE, Sondergaard E, Poulsen SH, et al. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction. J Am Soc Echocardiogr 2001;14(4):249-55.
22. Tei C. New non-invasive index for combined systolic and diastolic ventricular function J Cardiol 1995;26(2):135-6.
23. Popescu BA, Antonini-Canterin F, Temporelli PL, et al. Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudy. Heart 2005;91(4):484-8.
24. Ketikoglu DG, Karvounis HI, Papadopoulos CE, et al. Echocardiographic evaluation of spontaneous recovery of right ventricular systolic and diastolic function in patients with acute right ventricular infarction associated with posterior wall left ventricular infarction. Am J Cardiol 2004;93(7):911-3.