Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement

Soumik Ghosh; Salini Mukhopadhyay; Tusharkanti Patra

doi:doi:10.11648/j.ccr.20220601.17

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Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement

Soumik Ghosh, Salini Mukhopadhyay, Tusharkanti Patra

Published in Cardiology and Cardiovascular Research (Volume 6, Issue 1)

Received: 2 March 2022 Accepted: 26 March 2022 Published: 31 March 2022

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Abstract

Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.

Published in	Cardiology and Cardiovascular Research (Volume 6, Issue 1)
DOI	10.11648/j.ccr.20220601.17
Page(s)	45-49
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Inferior Wall Myocardial Infarction, Right Ventricular Infarction, Coronary Angiography, Right Ventricular Systolic Indices, Atrio-ventricular Block

References

[1]	Warner MJ, Tivakaran VS. Inferior Myocardial Infarction. [Updated 2021 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
[2]	Vanajakshamma V, Vyshnavi K, Latheef K et al. Right Ventricular Infarction in Inferior Wall Myocardial Infarction. Indian J Cardiovasc Dis Women-WINCARS 2017; 2: 29–34.
[3]	Md. Sohel Khan et al (2021). Clinical Profile of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction. Sch Int J Tradit Complement Med, 4 (10): 174-178.
[4]	Ondrus T, Kanovsky J, Novotny T, Andrsova I, Spinar J, Kala P. Right ventricular myocardial infarction: From pathophysiology to prognosis. Exp Clin Cardiol. 2013; 18 (1): 27-30.
[5]	Nagam MR, Vinson DR, Levis JT. ECG Diagnosis: Right Ventricular Myocardial Infarction. Perm J. 2017; 21: 16-105. doi: 10.7812/TPP/16-105.
[6]	Kukla P, Dudek D, Rakowski T, Dziewierz A, Mielecki W, Szczuka K, Dubiel JS. Inferior wall myocardial infarction with or without right ventricular involvement--treatment and in-hospital course. Kardiol Pol. 2006 Jun; 64 (6): 583-8; discussion 589-90.
[7]	Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol. 1974 Feb; 33 (2): 209-14.
[8]	Goldstein JA. Pathophysiology and management of right heart ischemia. J Am Coll Cardiol. 2002 Sep 4; 40 (5): 841-53.
[9]	Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C., American Heart Association Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Cardiovascular Surgery and Anesthesia. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement from the American Heart Association. Circulation. 2018 May 15; 137 (20): e578-e622.
[10]	Rajesh GN, Raju D, Nandan D, et al. Echocardiographic assessment of right ventricular function in inferior wall myocardial infarction and angiographic correlation to proximal right coronary artery stenosis. Indian Heart J. 2013; 65 (5): 522-528.
[11]	Robert AO, Louis J Dell'italia. Diagnosis and management of right ventricular myocardial infarction. Current Problems in Cardiology, 2004; 29 (1): 6-47.
[12]	Kumar V, Sinha S, Kumar P, et al. Short-term outcome of acute inferior wall myocardial infarction with emphasis on conduction blocks: a prospective observational study in Indian population. Anatol J Cardiol. 2017; 17 (3): 229-234.
[13]	Maha H. El Sebaie, Osama El Khatib. Right ventricular echocardiographic parameters for prediction of proximal right coronary artery lesion in patients with inferior wall myocardial infarction. Journal of the Saudi Heart Association, 2016; 28 (2): 73-80.
[14]	Vignon P, Weinert L, Mor-Avi V et al. Quantitative Assessment of Regional Right Ventricular Function with Color Kinesis. Am J Respir Crit Care Med 1999; 159: 1949–1959.
[15]	Jeffers JL, Boyd KL, Parks LJ. Right Ventricular Myocardial Infarction. [Updated 2021 Aug 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
[16]	Albulushi A, Giannopoulos A, Kafkas N, et al. Acute right ventricular myocardial infarction, Expert Review of Cardiovascular Therapy, 2018; 16 (7): 455-464.
[17]	Albaghdadi A, Teleb M, Porres-Aguilar M, Porres-Munoz M, Marmol-Velez A. The dilemma of refractory hypoxemia after inferior wall myocardial infarction. Proc (Bayl Univ Med Cent). 2018 Jan; 31 (1): 67-69.
[18]	Ashida T, Tani S, Nagao K, Yagi T, Matsumoto N, Hirayama A. Usefulness of synthesized 18-lead electrocardiography in the diagnosis of ST-elevation myocardial infarction: A pilot study. Am J Emerg Med. 2017 Mar; 35 (3): 448-457.
[19]	Venkatachalam S, Wu G, Ahmad M. Echocardiographic assessment of the right ventricle in the current era: Application in clinical practice. Echocardiography. 2017 Dec; 34 (12): 1930-1947.
[20]	Overgaard C, Fitchett D. Cardiogenic shock from right ventricular infarction. Cardiol Rounds. 2002; 7 (8).
[21]	Ashmawy MM, EI-Barbary YH, Hassib WA, Naguib CG. Assessment of Right Ventricular Function in Acute Inferior Wall Myocardial Infarction in Patients Treated with Primary Percutaneous Coronary Intervention. Research Journal of Cardiology, 2016; 9: 8-16.
[22]	Klein HO, Tordjman, Ninio R, et al. The early recognition of right ventricular infarction diagnostic accuracy of electrocardiographic lead V4R. Circulation. 1983; 67: 558.
[23]	Khaled El-Rabat E, Bastwesy RB, El Meligy NA et al. Predictors of complications among patients with acute inferior and right myocardial infarction. Research in Cardiovascular Medicine. 2019; 8 (4): 99-105.
[24]	Chhapra DA, Mahajan SK, Thorat ST. A study of the clinical profile of right ventricular infarction in context to inferior wall myocardial infarction in a tertiary care centre. J Cardiovasc Dis Res. 2013; 4 (3): 170-176.
[25]	Sethumadhavan R, Ponnusamy S. Echocardiographic assessment of right ventricular myocardial infarction. J. Evolution Med. Dent. Sci. 2018; 7 (47): 5063-5068.
[26]	Thirumurugan P, Rafic Babu AM. Assessment of Right Ventricular function by Echocardiograpy in Inferior wall Myocardial Infarction and Angiographic correlation to Proximal Right Coronary Artery Stenosis. IOSR Journal of Dental and Medical Sciences. 2017 (Sept); 16 (9): 36-40.
[27]	Meluzı´n J, Spinarova´ L, Bakala J, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J. 2001; 22: 340-348.

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APA Style

Soumik Ghosh, Salini Mukhopadhyay, Tusharkanti Patra. (2022). Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiology and Cardiovascular Research, 6(1), 45-49. https://doi.org/10.11648/j.ccr.20220601.17

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ACS Style

Soumik Ghosh; Salini Mukhopadhyay; Tusharkanti Patra. Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiol. Cardiovasc. Res. 2022, 6(1), 45-49. doi: 10.11648/j.ccr.20220601.17

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AMA Style

Soumik Ghosh, Salini Mukhopadhyay, Tusharkanti Patra. Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiol Cardiovasc Res. 2022;6(1):45-49. doi: 10.11648/j.ccr.20220601.17

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@article{10.11648/j.ccr.20220601.17,
  author = {Soumik Ghosh and Salini Mukhopadhyay and Tusharkanti Patra},
  title = {Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement},
  journal = {Cardiology and Cardiovascular Research},
  volume = {6},
  number = {1},
  pages = {45-49},
  doi = {10.11648/j.ccr.20220601.17},
  url = {https://doi.org/10.11648/j.ccr.20220601.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220601.17},
  abstract = {Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.},
 year = {2022}
}

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TY  - JOUR
T1  - Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement
AU  - Soumik Ghosh
AU  - Salini Mukhopadhyay
AU  - Tusharkanti Patra
Y1  - 2022/03/31
PY  - 2022
N1  - https://doi.org/10.11648/j.ccr.20220601.17
DO  - 10.11648/j.ccr.20220601.17
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 45
EP  - 49
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20220601.17
AB  - Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.
VL  - 6
IS  - 1
ER  -

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Author Information

Soumik Ghosh

Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
Salini Mukhopadhyay

Department of Anesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, India
Tusharkanti Patra

Department of Cardiovascular Science, Institute of Postgraduate Medical Education and Research, Kolkata, India

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APA Style

Soumik Ghosh, Salini Mukhopadhyay, Tusharkanti Patra. (2022). Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiology and Cardiovascular Research, 6(1), 45-49. https://doi.org/10.11648/j.ccr.20220601.17

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ACS Style

Soumik Ghosh; Salini Mukhopadhyay; Tusharkanti Patra. Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiol. Cardiovasc. Res. 2022, 6(1), 45-49. doi: 10.11648/j.ccr.20220601.17

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AMA Style

Soumik Ghosh, Salini Mukhopadhyay, Tusharkanti Patra. Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement. Cardiol Cardiovasc Res. 2022;6(1):45-49. doi: 10.11648/j.ccr.20220601.17

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@article{10.11648/j.ccr.20220601.17,
  author = {Soumik Ghosh and Salini Mukhopadhyay and Tusharkanti Patra},
  title = {Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement},
  journal = {Cardiology and Cardiovascular Research},
  volume = {6},
  number = {1},
  pages = {45-49},
  doi = {10.11648/j.ccr.20220601.17},
  url = {https://doi.org/10.11648/j.ccr.20220601.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220601.17},
  abstract = {Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.},
 year = {2022}
}

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TY  - JOUR
T1  - Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement
AU  - Soumik Ghosh
AU  - Salini Mukhopadhyay
AU  - Tusharkanti Patra
Y1  - 2022/03/31
PY  - 2022
N1  - https://doi.org/10.11648/j.ccr.20220601.17
DO  - 10.11648/j.ccr.20220601.17
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 45
EP  - 49
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20220601.17
AB  - Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.
VL  - 6
IS  - 1
ER  -

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