Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction

Right ventricular myocardial infarction (RVMI) damages the systolic and diastolic functions of the RV, so the right atrium interacts with the RV with an acutely altered function. The aim of our study was to compare right atrial function as evaluated by 2D speckle-tracking echocardiography (2DSTE) between patients with inferior wall myocardial infarction (INFMI) and patients affected by both inferior myocardial infarction and right ventricular myocardial infarction (INFMI?+?RVMI). Our study recruited 70 consecutive patients with INFMI (43 patients without RVMI and 27 patients with RVMI). Right atrial function was evaluated by 2DSTE. Early diastolic strain, systolic strain rate, absolute value of early diastolic strain rate, expansion index, and diastolic emptying index of the right atrium were reduced in the patients with INFMI?+?RVMI compared to the patients with INFMI. The area under the curve for early diastolic strain for INFMI diagnosis was 0.682 (p value?=?0.011, 95?% CI 0.550–0.815). Right atrial early diastolic longitudinal strain <27.5?% had 59.3?% sensitivity and 79.1?% specificity for the discrimination of INFMI?+?RVMI from INFMI. Our results demonstrated that right atrial reservoir and conduit functions were impaired in the patients with INFMI?+?RVMI compared with the patients with INFMI.     

Electrocardiographic manifestations: acute inferior wall myocardial infarction

The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.     

The electrocardiogram in right ventricular myocardial infarction

Right ventricular (RV) myocardial infarction most often occurs in the setting of inferior wall myocardial infarction. Right ventricular infarction complicates approximately 25% (range, 20%-60%) of inferior acute myocardial infarction; it is uncommon to quite rare in anterior and lateral wall acute myocardial infarction. With infarction of the RV, the RV will fail. As such, left ventricular filling pressures are entirely dependent upon the patient's preload; with significant reductions in the preload, hypotension likely results (this hypotension may be worsened by nitroglycerin and morphine). The clinical presentation, in the setting of an ST-elevation myocardial infarction (STEMI) of the inferior wall, involves hypotension, jugular venous distension, and the following electrocardiographic findings: ST-segment elevation of greatest magnitude in lead III (compared with leads II and aVF), ST-segment elevation in lead V1, and/or ST-segment elevation in right chest leads (RV1 through RV6). Therapy, in addition to appropriate management for STEMI, relies largely on enhancing the preload with intravenous fluid and judicious use of vasodilator medications. Patients with inferior wall STEMI with RV infarction have a markedly worse prognosis (both acute cardiovascular complications and death) compared with patients with isolated inferior wall STEMI.     

Right ventricular myocardial infarction

Right ventricular myocardial infarction (RVMI) is recognized as an important clinical entity. The clinical course of patients with RVMI may be benign, or it may progress to profound hypotension and cardiogenic shock. The medical and nursing management of these patients differs significantly from that of patients with left ventricular infarction. The nurse must be familiar with the clinical signs and medical treatment of RVMI to facilitate early diagnosis and to plan appropriate acute and long-term nursing management of these patients.     

Role of 2-dimensional speckle tracking echocardiography in diagnosis of right ventricular involvement in patients with inferior wall myocardial infarction undergoing primary percutaneous coronary intervention

The International Journal of Cardiovascular Imaging - Diagnosis of right ventricular (RV) infarction in the setting of acute inferior wall myocardial infarction (IWMI) has important prognostic...     

超声心动图对急性心肌梗塞后左心室结构和功能的评价

目的 动脉观察急性心肌梗塞后左室结构和功能的变化,评价溶栓治疗对梗塞后心室重构的影响。方法 对２８例首发急性心肌梗塞患者于梗塞后第４周和第１２周进行超声心动图观察。所测参数有：左室舒张末期和收缩末期容积指数（ＬＶＥＤＶＩ,ＬＶＥＳＶＩ）及射血分数（ＥＦ）。结果 急性心肌梗塞患者ＬＶＥＤＶＩ,ＬＶＥＳＶＩ均明显增高;栓组ＬＶＥＤＶＩ,ＬＶＥＳＶＩ无明显变化,ＥＦ升高,未溶栓组ＬＶＥＤＶＩ,ＬＶＥＳＶ     

Two cases of diagnosis of right ventricular myocardial infarction

Right ventricular myocardial infarction (RVMI) occurs rather rarely, under the mask of various diseases and is not easy to detect. Hypo-vate prognosis. Intravital diagnosis of RVMI was successful in 4 patients. Location of the lesion and its extent were determined. This article reports two cases of the four. The disease onset manifested with dyspnea, dry cough, attacks of night asphyxia then symptoms of right ventricular failure arose and intensified. The clinical picture, typical ECG signs suggested the RVMI diagnosis. However, its verification, precise localization and estimation of the lesion size were possible only after balanced radioventriculography.     

V1R波增高、STV2改变对下壁心梗的临床诊断价值

目的:针对下壁心梗,研究分析V1R波增高、STV2改变的临床诊断价值。方法:以2017年6月-2019年6月我院收录的总计58例下壁心梗患者为对象,对所有患者进行24h的动态心电图检查,观察分析V1R波增高以及STV2的改变情况。结果:经过检测,25例的单纯下壁心梗患者中出现V1R波增高的有6例(24.00%),STV2改变(其中STV2变低的有5例,STV2变高的有3例)的有8例(32.00%);19例的下壁伴随正后壁心梗患者中出现V1R波增高的有15例(78.95%),STV2改变(均为STV2变低)的有18例(94.74%);14例的下壁伴随右心室心梗患者中出现V1R波增高的有7例(50.00%),STV2改变(均为STV2变高)的有12例(85.71%);下壁伴随正后壁心梗患者以及下壁伴随右心室心梗患者的V1R波增高以及STV2的改变情况与单纯下壁心梗患者相比明显更高,差异有统计学意义(P<0.05)。结论:针对下壁心梗患者的诊断,当出现V1R波增高以及STV2改变的情况时,应该对患者进行进一步检测。     

常规十二导联诊断急性下壁心肌梗塞的效果观察

目的：以单纯性下壁心肌梗塞为对照,探讨右室心肌梗塞合并急性下壁心肌梗塞的12导联心电图特征.材料与方法：2010年1月至2013年8月间诊治的22例右室心肌梗塞合并急性下壁心肌梗塞患者列入研究组,同期48例单纯下壁心肌梗塞患者列入对照组,回顾性观察两组患者常规12导联心电图特征,并进行比较分析.结果：ST段抬高幅度比较,研究组Ⅲ＞ⅡI的检出率为90.1％,对照组仅4.2％,研究组明显高于对照组,数据经统计学比较具有极显著差异（P＜0.01）,检验特异性为90.1％;ST段在V2导联中压低幅度和aVF导联中抬高幅度的比值比较,研究组≤0.5的患者比例为81.8％,明显高于对照组的比例4.2％,数据经统计学比较具有极显著差异（P＜0.01）,检验特异性为90％.结论：利用常规12导联心电图诊断急性下壁心肌梗塞是否合并有右室心肌梗塞具有较高的特异性和敏感性,当ST段抬高幅度出现Ⅲ＞ Ⅱ时,或ST段在V2导联中压低幅度和aVF导联中抬高幅度的比值≤0.5时,均提示较大可能性的右室心肌梗塞发生.     

Acute right ventricular myocardial infarction

Introduction: Acute right ventricular myocardial infarction (RVMI) is observed in 30–50% of patients presenting with inferior wall myocardial infarction (MI) and, occasionally, with anterior wall MI. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia.

Areas covered: The pathophysiological mechanisms, diagnostic steps, and novel therapeutic approaches of acute RVMI are described.

Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography, and coronary angiography, whereas noninvasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role. Early revascularization, percutaneous or pharmacological, represents key step in the management of RMVI. Maintenance of reasonable heart rate and atrioventricular synchrony is essential to sustain adequate cardiac output in these patients. When conventional treatment is not successful, mechanical circulatory support, including right ventricle assist devices, percutaneous cardiopulmonary support, and intra-aortic balloon pump, might be considered. The prognosis associated with RVMI is worse in the short term, compared to non-RVMI, but those patients who survive hospitalization have a relatively good long-term prognosis.     

Right ventricular infarction

Right ventricular infarction is present in up to 80% of autopsy specimens following fatal myocardial infarction. The clinical features suggestive of right ventricular infarction such as raised systemic venous pressure, clear lung fields, hypotension and atrio-ventricular nodal disturbances usually occur in association with inferior myocardial infarction, with an incidence of 30–50%. Kussmaul‘s sign of a paradoxical rise in the jugular venous pressure wave on inspiration is both sensitive and specific for right ventricular infarction. A 1mm rise in the V4R ST segment on ECG has a positive predictive value for right ventricular infarction of over 70%, increasing to 90% with the addition of ST elevation in leads VSR and V6R. ECG changes are often transient. Acute management of right ventricular infarction includes fluid loading and inotropic support with dobutamine as necessary, with avoidance of vasodilators and diuretics. Mortality from acute myocardial infarchon is increased by right ventricular infarction, but may be lessened by thrombolytic therapy in eligible patients.     

急性下壁心肌梗死胸前导联ST段压低的临床意义

目的分析急性下壁心肌梗死伴胸前导联ST段压低的临床意义。方法选择84例急性下壁心肌梗死患者常规心电图及24h动态心电图进行对照分析。结果急性下壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低（P〈0．01）;下壁伴正后壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低（P〈0．01）;下壁伴右心室心肌梗死与胸前导联ST段压低无明显关联（P〈0．01）;急性下壁心肌梗死伴胸前导联ST段压低者严重室性心律失常与房室传导阻滞的发生率较不伴胸前导联ST段压低者高（P〈0．01）。结论急性下壁心肌梗死伴胸前导联ST段压低往往提示梗死范围大或同时存在心肌缺血、冠脉病变广泛、心功能损害较严重,并且严重室性心律失常与房室传导阻滞的发生率明显增高,心肌酶峰值明显增高临床预后较差。     

实时三维超声心动图、二维斑点追踪技术联合血浆游离细胞DNA评估急性下壁心肌梗死伴右室心肌梗死患者右心房各时相容积改变及心肌受损情况的临床价值

目的：探讨实时三维超声心动图（RT-3DE）、二维斑点追踪技术（2D-STI）联合血浆游离细胞DNA（cf DNA）评估急性下壁心肌梗死（AIMI）伴右室心肌梗死（RVMI）患者右心房（RA）各时相容积改变及心肌受损情况的临床价值。方法：选择2018年1月-2021年1月于本院初诊为AIMI的98例患者，根据AIMI患者是否合并RVMI可分为AIMI组（50例）和AIMI+RVMI组（48例）；另外选取38例体检健康者作为对照组。术前均行常规二维超声心动图、RT-3DE、2D-STI检查以及血浆cf DNA检测。分析AIMI伴RVMI患者RA的RT-3DE、2D-STI测量指标与RV测量指标、血浆cf DNA水平之间的相关性。评估RT-3DE、2D-STI、血浆cf DNA单独或联合诊断AIMI伴RVMI的诊断效能。结果：AIMI组的常规二维超声心动图、RA的RT-3DE以及2D-STI测量指标与对照组之间的差异均无统计学意义（P>0.05）。而AIMI+RVMI组E/e’、RA的RT-3DE测量指标（RAVmaxI、RAVminI、RAVpreI、TSVI、PSVI以及ASVI）显著高于对照组及AIMI组（P<0.05），而e’、TAPSE、PEF以及RA的2D-STI测量指标（LStot、LSpos）显著低于对照组及AIMI组（P<0.05）。AIMI+RVMI组的血浆cf DNA水平显著高于对照组及AIMI组（P<0.05），而AIMI组的血浆cf DNA水平也显著高于对照组（P<0.05）。AIMI伴RVMI患者RA的RT-3DE测量指标（RAVmaxI、RAVminI、RAVpreI）均与E/e’、血浆cf DNA水平呈正相关（P<0.05），而与TAPSE呈负相关（P<0.05）；AIMI伴RVMI患者RA的2D-STI应变功能测量指标（LStot、LSpos）均与E/e’、血浆cf DNA水平呈负相关（P<0.05），而与TAPSE呈正相关（P<0.05）。RT-3DE、2D-STI联合血浆cf DNA水平诊断AIMI伴RVMI的准确性、敏感度、特异度、阳性预测值、阴性预测值最高（P<0.05）。结论：RT-3DE、2D-STI联合血浆cf DNA水平将有助于提高AIMI伴RVMI的诊断效能，并有利于对AIMI伴RVMI患者RA各时相容积改变及心肌受损情况的评估，进一步为临床治疗方案的选择提供诊断依据。     

静脉溶栓治疗对急性心肌梗塞远期预后的影响

目的：观察静脉溶栓治疗对急性心肌梗塞（ＡＭＩ）患者远期预后的影响。方法：采用超声心动图、２４小时动态心电图、心电图运动试验及心室晚电位检查，对９４例接受溶栓治疗的ＡＭＩ患者进行６个月～３年的随访。结果：在６个月～３年的随访中，前壁再通组左房内径（ＬＡＤ）、左室舒张末内径（ＬＶＥＤ）和左室射血分数（ＬＶＥＦ）均明显短于前壁未通组（Ｐ均＜０．０５）；而下壁再通组与未通组ＬＡＤ、ＬＶＥＤ和ＬＶＥＦ无明显差别。再通组各种心律失常的发生率明显低于未通组，再通组的运动耐量明显高于未通组（Ｐ均＜０．０５）。结论：静脉溶栓对改善前壁心肌梗塞患者远期心功能疗效显著，对下壁心肌梗塞患者心功能改善不明显；但静脉溶栓对前壁或下壁心肌梗塞患者，在减少远期心律失常的发生，增强运动耐量和提高生活质量方面均有着重要意义。     

急性下壁心肌梗死胸前导联ST段改变的临床意义

目的分析急性下壁心肌梗死伴胸前导联ST段压低的临床意义。方法选择38例急性下壁心肌梗死患者常规心电图及24h动态心电图进行对照分析。结果急性下壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴正后壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴右心室心肌梗死与胸前导联ST段压低无明显关联(P<0.01);急性下壁心肌梗死伴胸前导联ST段压低者严重室性心律失常与房室传导阻滞的发生率较不伴胸前导联ST段压低者高(P<0.01)。结论急性下壁心肌梗死伴胸前导联ST段压低往往提示梗死范围大或同时存在心肌缺血、冠脉病变广泛、心功能损害较严重,并且严重室性心律失常与房室传导阻滞的发生率明显增高,心肌酶峰值明显增高临床预后较差。     

组织谐波成像在急性心肌梗死诊断中的应用--与冠状动脉造影对照研究

目的 探讨组织谐波成像(THI)技术在急性心肌梗死诊断中的应用价值。方法 分析经THI及冠状动脉造影检查的101例急性心肌梗死患者的临床资料。结果 图像满意和较满意率达96．0％。THI对急性心肌梗死检出率为91．1％。THI与心电图估测心肌梗死部位及范围基本一致。THI估测心肌梗死部位与冠状动脉造影所示梗死相关动脉供血区域基本相符(准确率87．1％)，其中以检出左前降支病变所致心肌梗死的准确率最高(96．8％)；下壁、后壁或右室梗死常合并其他部位心肌梗死，较易漏诊。结论 THI是检测急性心肌梗死敏感而准确的方法，可与心电图相互印证、相互补充。检查中应特别注意有无合并下壁、后壁或右室梗死，以免漏诊。     

急性下壁心肌梗死累及右心室的冠状动脉特点及近期预后

目的：研究急性下壁心肌梗死累及右心室者的冠状动脉闭塞部位及近期预后。方法：观察急诊及住院的96例急性下壁心肌梗死患者，其中右心室梗死43例（A组），单纯下壁梗死53例（B组）。结果：A组冠状动脉造影30例，全部为右冠闭塞，近中端闭塞23例，远端7例；B组造影38例，右冠闭塞19例，近中端10例，远端9例，回旋支闭塞19例。A组合并的其它血管病变比B组更严重。A组肌酸磷酸肌酶峰值高于B组，P〈0.01；A组心源性休克发生率20．9％，病死率16．2％，B组均为0例，均P〈0．01。结论：右冠近、中、远端闭塞均可发生右心室梗死；合并右心室梗死者近期预后较单纯下壁梗死者差，其发生心源性休克且常常不可逆的原因为右冠近中端完全闭塞同时还合并有多支血管的严重病变。     

急性下壁心肌梗死患者的临床特点分析

目的 分析研究急性下壁心肌梗死患者的临床特点. 方法 将急性下壁心肌梗死患者100例根据冠状动脉造影结果分为两组:76例为右冠状动脉(RCA)闭塞(A组),24例为左回旋支冠状动脉(LCX)闭塞(B组). 结果 心电图ST段抬高STⅢ>STⅡ及ST段压低STAVL>ST I A组显著高于B组(均P<0.05);ST段抬高STⅢ0.1 mV A组显著高于B组(P<0.05);胸前导联V1～6ST段压低患者中,合并左前降支冠状动脉(LAD)病变的患者显著高于胸前导联V1～6ST段无压低者(P<0.05);左心室射血分数(LVEF)A组[(51±14)%]显著低于B组[(57±10)%](P<0.05);合并右心室心肌梗死A组显著高于B组(P<0.05);急性下壁心肌梗死患者总的住院病死率6%,均为A组,但心源性休克、心力衰竭、Ⅱ、Ⅲ度房室传导阻滞,室性心动过速/心室颤动及住院病死率,两组差异均无统计学意义(均P>0.05);死亡者中心源性休克占83.3%. 结论 心电图Ⅲ、Ⅱ、I、AVL、及V4R导联ST段变化能预测急性下壁心肌梗死相关血管,急性下壁心肌梗死患者伴胸前导联ST段压低提示LAD病变,RCA闭塞所致下壁心肌梗死LVEF低于LCX闭塞者,心源性休克为死亡主要原因.     

组织追踪和应变率显像技术评价右室心肌梗死患者右室收缩功能

目的 探讨超声组织追踪（TTI）和应变率显像（SRI）技术在诊断右室壁心肌梗死和评价右室局部收缩功能中的临床应用价值.方法 采用TTI和SRI技术对20例急性右室梗死患者和24例健康对照者的右室心尖两腔心切面和四腔心切面进行扫查,检测分析右室前壁、下壁、侧壁收缩期峰值位移值（PDS）、收缩期最大应变率（SSR）.结果 右室心肌梗死患者的PDS和SSR均较对照组降低（P＜0.05）,而SSR较PDS显示结果更敏感（P＜0.01）.结论 TTI和SRI技术能够准确地诊断右室壁心肌梗死,并能对右室局部收缩功能进行定量评价     

Computer-assisted analysis of wall motion of the right ventricle in a normal patient sample and diagnosis of right heart infarction using transesophageal echocardiography

Using 2D and M-Mode transesophageal short axis cross sections, right ventricular systolic wall motion was quantified in 15 normal patients. A further group of 39 patients with right ventricular infarction was investigated. In the normal group fractional shortening of the septum was -19.6% (-45 to 8%), that of the lateral wall 51.6% (37 to 73%), of the posterior wall 33.9% (5 to 50%) and of the anterior wall 42.7% (18 to 57%). Right ventricular infarction (RVI) was associated in 33 patients with posterior left ventricular infarction (85%) and in three patients with anterior infarction. In two cases only an isolated RVI was found. Right ventricular dilation occurred in 24 patients (61%). Hemodynamic criteria were fulfilled in eleven out of 21 patients (53%). RVI was confirmed in one patient by surgery and in ten patients by autopsy. Recognition of regional wall motion abnormalities by transesophageal echocardiography permits an accurate bedside identification of RVI. 2D and M-Mode registration of the short axis improves RVI assessment. Wall motion analyses offer the possibility to determine the extent of right ventricular infarction.