P968Prognostic significance of right ventricular systolic myocardial velocity in acute inferior myocardial infarction treated invasively.


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Abstract

Purpose: Right ventricular (RV) involvement in pts with inferior myocardial infarction (IMI) leads to increased early mortality and morbidity. RV myocardial velocities were shown to be indicators of RV systolic and diastolic function. The aim of the study was to evaluate prognostic significance of RV myocardial velocities for in-hospital complications in pts with first IMI treated by primary percutaneous coronary intervention (pPCI).Methods: 101 pts (58% males, mean age 64±11) with first acute IMI with ST-elevation (STEMI) treated by pPCI were prospectively assessed. Echo with TDI was performed post pPCI within 24 hours from the onset of symptoms. In TDI a peak systolic myocardial velocity (Sm) and peak early diastolic velocity (Em) for RV free wall were obtained. Combined end-point was defined when first of the following occurred in hospital: cardiovascular death, cardiogenic shock, cardiac rupture, recurrent MI, rescue PCI, recurrent pain with ecg ischaemic changes, symptomatic hypotension, IIo/IIIo A-V block, need for intracardiac pacing or intraaortic balloon pump. SmRV, EmRV, age, extend of myocardial infarction expressed as peak troponin I, LV ejection fraction (EF), ST segment elevation ≥0.1 mV in V4R, impaired flow in infarct related artery post pPCI (TIMI 0-2) were included in multivariate logistic regression analysisResults: Combined end-point occurred in 29 (29%) pts. SmRV and ST segment elevation ≥0.1 mV in V4R were found to be independent predictors of early, in-hospital prognosis (table). Model was well fitted (in goodness of fit test P=0.96) and had high diagnostic significance (ROC 0.79)Conclusion: Decreased RV systolic myocardial Doppler velocity independently of ECG changes predicts unfavourable clinical outcome in patients with inferior STEMI.

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