Right ventricle myocardial performance index versus Simpson's right ventricle ejection fraction in patients with isolated left ventricle anterior myocardial infarction

ABSTRACT

Right ventricle [RV] dysfunction may be secondary to left ventricle [LV] dysfunction in patients of isolated left ventricle anterior myocardial infarction as a consequence of "Ventricular Interdependence". As RV dysfunction is associated with high in-hospital morbidity and mortality, early recognization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. Our aim in the present study was to compare Simpson's right ventricle ejection fraction [RVEF] with right ventricle myocardial performance index [RV-MPI] to predict RV function in patients with isolated left ventricle anterior myocardial infarction [LV-AMI]. We conducted the present study at the Department of Cardiology of Jawahar Lal Nehru Medical College and Associate Group of Hospitals, Ajmer. The control group comprised of twenty five. Age, sex, BMI, pulse and blood pressure matched healthy subjects without history of heart disease, systemic hypertension, diabetes, any other systemic illness and with normal findings in resting and exercise ECG, Echocardiography and Coronary Angiography. Sub-group-1 consisted of 25 patients with hemodynamically significant stenosis of proximal left anterior descending artery [LAD] with patent first septal perforator [S[1]]. Sub-group-2 was composed of s5 patients with hemodynamically significant stenosis of both LAD and left circumflex artery [LCx.]. Both subgroups had fully patent right coronary artery [RCA] from proximal to distal end. RV-MPI value determined using pulsed doppler echocardiography was 0.40 +/- 0.19 in healthy subjects. However RV-MPI was increased in both subgroups of LV-AMI with significant increase in subgroup-2 [P <0.005] as compared to subgroup-1 patients [P <0.01]. Simpson's RVEF was not significantly different between the groups [P >0.05]. The findings in this study demonstrate that RV-MPI is a more sensitive, non-geometric echocardiographic parameter than Simpson's RVEF in detecting early RV dysfunction. Early detection of RV dysfunction is important to reduce morbidity and mortality in these patients