Espinola-Zavaleta Nilda, Gonzalez-Velasquez Pablo José, Gopar-Nieto Rodrigo, Camacho-Camacho Gyselle, Solorzano-Pinot Enrique, Fernández-Badillo Valente, Berarducci Joaquin, Armenta-Moreno Javier Ivan, Alexanderson-Rosas Erick
Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, 14080 Mexico City, Mexico.
Department of Echocardiography, ABC Medical Center I. A. P., 01120 Mexico City, Mexico.
Rev Cardiovasc Med. 2022 Apr 1;23(4):123. doi: 10.31083/j.rcm2304123. eCollection 2022 Apr.
In patients with inferior myocardial infarction (MI), involvement of the right chambers has a prognostic impact. The objective of this study was to evaluate the influence of left ventricular (LV) inferior wall MI in the right atrial (RA), and right ventricular (RV) longitudinal strain (LS) by 2D speckle tracking echocardiography (STE).
60 consecutive patients who underwent myocardial perfusion (MP) gated SPECT for chest pain were included. We studied 30 patients with LV inferior MI and 30 control subjects with normal MP. RV ejection fraction was measured by 3D transthoracic echocardiography, RV-free wall LS and RA reservoir, contraction, and conduit phases strain were analyzed by 2D speckle tracking echocardiography (STE).
The median age in the LV inferior MI was 65 (54-70) years, 27% had a transmural myocardial infarction and 47% had residual myocardial ischemia, most of them, mild (36.7%). RV-free wall LS (-26.1 vs -30.3, 0.01), RA LS-reservoir phase (31.5 vs 56.2, 0.01), and RA-conduit phase LS (12.5 vs 35, = 0.01) were significantly lower in the LV inferior MI patients compared to control subjects. In a logistic regression model, the MI of the LV reduced the 3D ejection fraction of both ventricles, mitral regurgitation, and pulmonary hypertension were associated with a decrease in RV LS and RA LS.
This study shows that RV free wall LS, RA peak strain (reservoir phase), and RA conduit phase strain were significantly lower in patients with LV inferior MI vs control individuals. Subclinical extension to the RV in the inferior MI of the LV and its role in the longitudinal strain of RA could be determined using speckle tracking echocardiography.
在下壁心肌梗死（MI）患者中，右心室受累对预后有影响。本研究的目的是通过二维斑点追踪超声心动图（STE）评估左心室（LV）下壁MI对右心房（RA）和右心室（RV）纵向应变（LS）的影响。
纳入60例因胸痛接受心肌灌注（MP）门控SPECT检查的连续患者。我们研究了30例左心室下壁MI患者和30例MP正常的对照受试者。通过三维经胸超声心动图测量右心室射血分数，通过二维斑点追踪超声心动图（STE）分析右心室游离壁LS以及右心房储备、收缩和管道期应变。
左心室下壁MI患者的中位年龄为65（54 - 70）岁，27%有透壁心肌梗死，47%有残余心肌缺血，其中大多数为轻度（36.7%）。与对照受试者相比，左心室下壁MI患者的右心室游离壁LS（-26.1对-30.3，P = 0.01）、右心房LS储备期（31.5对56.2，P = 0.01）和右心房管道期LS（12.5对35，P = 0.01）显著降低。在逻辑回归模型中，左心室MI降低了两个心室的三维射血分数，二尖瓣反流和肺动脉高压与右心室LS和右心房LS降低相关。
本研究表明，与对照个体相比，左心室下壁MI患者的右心室游离壁LS、右心房峰值应变（储备期）和右心房管道期应变显著降低。使用斑点追踪超声心动图可以确定左心室下壁MI中右心室的亚临床扩展及其在右心房纵向应变中的作用。
