Naseem Mohamed, Samir Sameh
Cardiovascular Medicine Department, Tanta Faculty of Medicine, Egypt.
J Saudi Heart Assoc. 2021 Jan 8;32(4):500-508. doi: 10.37616/2212-5043.1208. eCollection 2020.
Patients with right ventricular (RV) infarctions associated with inferior infarctions have higher rates of adverse events than isolated inferior infarctions. Right atrial volume index (RAVI) has recently been described as a predictor of clinical outcome in patients with chronic systolic heart failure and pulmonary hypertension. The aim of this study is to assess the ability of RAVI to predict the persistent RV dysfunction after acute inferior STEMI due to occlusion of proximal RCA. To the best of our knowledge, this is the first study to investigate the relation between RAVI and persistent RV dysfunction in such group of patients.
Sixty-five consecutive patients with recent first acute inferior STEMI who underwent primary percutaneous coronary intervention (PPCI) were prospectively included in the study. Echocardiographic evaluation was performed at the time of discharge and at 3 months. All the patients underwent standard echocardiographic assessment using conventional 2D and tissue Doppler imaging (TDI).
Patients were divided into two groups according to right ventricular function (RVF) 3 months after acute myocardial infarction (AMI). The normal RVF group included 41 (63%) patients and the impaired RVF group included 24 (37%) patients. RAVI was significantly higher in patients with impaired RVF (p=<0.001). RAVI was a predictor of persistently impaired RV function (odds ratio = 1.786, 95% confidence interval, 1.367-2.335, p value= <0.001) and (odds ratio = 1.829, 95% confidence interval, 1.358-2.462, p value= <0.001) in univariate and multivariable logistic regression analyses respectively. In receiving operator characteristics (ROC) curve analysis, RAVI with a cutoff value ≥ 30 ml/m had a 87.5% sensitivity, a 92.24% specificity area under Receiving operator characteristics (ROC) curve = 0.964 for predicting persistently impaired RVF.
In patients with inferior STEMI with proximal RCA occlusion, RAVI is an independent predictor of persistently impaired RVF with a cut-off value ≥ 30 ml/m.
与单纯下壁心肌梗死相比，合并下壁心肌梗死的右心室（RV）梗死患者不良事件发生率更高。右心房容积指数（RAVI）最近被描述为慢性收缩性心力衰竭和肺动脉高压患者临床结局的预测指标。本研究的目的是评估RAVI预测因近端右冠状动脉（RCA）闭塞导致的急性下壁ST段抬高型心肌梗死（STEMI）后持续性右心室功能障碍的能力。据我们所知，这是第一项研究此类患者中RAVI与持续性右心室功能障碍之间关系的研究。
连续65例近期首次发生急性下壁STEMI且接受了直接经皮冠状动脉介入治疗（PPCI）的患者被前瞻性纳入本研究。在出院时和3个月时进行超声心动图评估。所有患者均使用传统二维和组织多普勒成像（TDI）进行标准超声心动图评估。
根据急性心肌梗死（AMI）后3个月的右心室功能（RVF）将患者分为两组。正常RVF组包括41例（63%）患者，RVF受损组包括24例（37%）患者。RVF受损患者的RAVI显著更高（p =<0.001）。在单变量和多变量逻辑回归分析中，RAVI分别是持续性右心室功能受损的预测指标（比值比 = 1.786，95%置信区间，1.367 - 2.335，p值 =<0.001）和（比值比 = 1.829，95%置信区间，1.358 - 2.462，p值 =<0.001）。在受试者工作特征（ROC）曲线分析中，截断值≥30 ml/m²的RAVI预测持续性RVF受损的敏感性为87.5%，特异性为92.24%，受试者工作特征（ROC）曲线下面积 = 0.964。
在近端RCA闭塞的下壁STEMI患者中，RAVI是持续性RVF受损的独立预测指标，截断值≥30 ml/m²。
