RESUMO
Patients with inferior acute myocardial infarction [MI] and right ventricular [RV] MI represent a high-risk. Moreover, RV function is difficult to evaluate, given its geometry, inter relation with left ventricle, and sensitivity to load. Data concerning percutanous coronary intervention [PCI], RV dysfunction and prognosis are scared. To test the value of pulsed Doppler tissue imaging [DTI] to delineate RV dysfunction in acute inferior Ml and to determine the value of RV artery [RVA] patency following rescue PCI on RV functional recovery and short tern: clinical outcome. 40 patients with acute inferior MI who underwent rescue PCI to the right coronary artery. Tricuspid annulus [TA] and RV free wall DTI used to measure systolic [Sm] and diastolic [Em and Am] myocardial velocities plus myocardial power index [MPI=isovolu, nic relaxation+isovolumic contraction/ejection times]. According to RVA patency pts were divided into two groups [group I occluded RVA=21 pts, group 11 patent RVA=19 pts]. Data were compared to 12 control subjects. Electrocardiographic RV MI was confirmed in 14 pts [35%]. DTI revealed RV dysfunction in all pts vs. control [TA [9.31 +/- 0.36, 9.80 +/- 0.39, 12.1 +/- 0.05 cm/sec and 0.71+0.12 vs. 15.6 +/- 2.3 16.21 +/- 1.85 15.9 +/- 1.25 cm/sec and 0.55+0.14 for Sm, Em, Am, and MPI p<0.01] and RV free wall [10.9 +/- 3.1, 8.6 +/- 1.8, 13.8 +/- 3.1 cm/sec and 0.74 +/- 0.13 vs. 14.3 +/- 3.2, 10.1 +/- 3.4, 14.8 +/- 4.4 cm/sec and 0.54 +/- 0.15 for Sm, Em, Am, and MPI p<0.02]] Pts with RVMI had more severe RV dysfunction [TA [6.37 +/- 0.28, 6.11 +/- 0.48, 8.36 cm/sec and 0.86 +/- 0.23 for Sm, Em, Am, and MPI p<0.001] and RV free wall [6.81 +/- 4.21, 4.95 +/- 2.62, 10.64 +/- 2.93 un/sec and 0.91 +/- 0.21 for Sm, Em, Am, and MPI P<0.001]]. Similarly pts with occluded RVA had significantly lower RV free wall and TA velocities and higher MPI I [10.9 +/- 1.3, 8.9 +/- 0.39, 9.6 +/- 0.83 cm/sec and 0.83 +/- 0.llfor RVfree wall Sm, Em, An, and MPI p<0.05] and [8.20 +/- 0.47, 8.90 +/- 0.28, 11.2 +/- 0.09 cm/sec and 0.78+0.22 for TA Sm, Em, Am, and MPI p<0.0l]]. After PCI, pts with patent RVA showed significant improved RV function [high RV and TA velocities with low [MPI] with less in hospital [9/21 vs. 2/19 p=0.034], and 3 months events [7/21 vs. 1/19 p=0.046]. Doppler tissue imaging is highly sensitive to detect subclinical R V dysfunction in patients with acute inferior myocardial infarction. Successful reperfusion of R V artery was associated with better recovery of RV function and less short term clinical adverse cardiac events