Rallidis Loukianos S, Makavos Georgios, Nihoyannopoulos Petros
Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
J Am Soc Echocardiogr. 2014 Mar;27(3):223-9. doi: 10.1016/j.echo.2013.12.001. Epub 2014 Jan 10.
The right ventricle differs from the left ventricle in many anatomic and physiologic aspects. This disparity renders the right ventricle less vulnerable to ischemia and less susceptible to myocardial injury when right coronary artery occlusion occurs compared with the extent of left ventricular dysfunction during left coronary artery occlusion. Acute right ventricular (RV) myocardial infarction is usually caused by proximal right coronary artery occlusion and therefore is usually associated with inferior myocardial infarction. Conventional echocardiography along with Doppler tissue imaging has played a significant role in early diagnosis of RV myocardial infarction and has a role in prognostic stratification. Stress echocardiography is less validated and more technically demanding in detecting RV reversible dysfunction compared with left ventricular dysfunction. The threshold of RV ischemia during stress echocardiography is higher compared with left ventricular ischemia and usually affects the inferior RV wall. Further studies, particularly with the use of novel echocardiographic techniques such as speckle-tracking and three-dimensional echocardiography, may be required to better elucidate the role of the right ventricle in coronary artery disease.
右心室在许多解剖和生理方面与左心室不同。这种差异使得右心室在右冠状动脉闭塞时比左冠状动脉闭塞时左心室功能障碍的程度更不易发生缺血，更不易受到心肌损伤。急性右心室心肌梗死通常由右冠状动脉近端闭塞引起，因此通常与下壁心肌梗死相关。传统超声心动图以及多普勒组织成像在右心室心肌梗死的早期诊断中发挥了重要作用，并且在预后分层中也有作用。与检测左心室功能障碍相比，负荷超声心动图在检测右心室可逆性功能障碍方面的验证较少，技术要求更高。负荷超声心动图期间右心室缺血的阈值高于左心室缺血，并且通常影响右心室下壁。可能需要进一步的研究，特别是使用散斑追踪和三维超声心动图等新型超声心动图技术，以更好地阐明右心室在冠状动脉疾病中的作用。
