Assessment of Right Ventricular Diastolic Function by Tissue Doppler Imaging in Patients with Acute Right Ventricular Myocardial Infarction

Background: It is known that right ventricular systolic parameters as assessed by color tissue Doppler imaging (TDI) are abnormal in patients with inferior wall ST elevation myocardial infarction (IWMI) with right ventricular myocardial infarction (RVMI). This study was undertaken to determine right ventricular diastolic function as assessed by TDI in patients with acute RVMI. Methods: Thirty‐five patients with first IWMI were studied and compared with 20 age‐matched healthy controls, and categorized into those with (14 patients) and without (21 patients) RVMI based on standard ECG criteria. Peak systolic, peak early and late diastolic velocities (Sm, Em, and Am), Em/Am ratio along with time to Sm (ECG Q‐Sm) and time to Em (ECG Q‐Em) were acquired from the apical 4‐chamber view at the lateral side of tricuspid annulus using TDI. Results: Sm, Em, and Em/Am ratio was reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm [11.1 ± 2.9] vs. [14 ± 1.9] and [14.5 ± 2.1] cm/sec, P < 0.01; Em [9.2 ± 3.5] vs. [12.9 ± 3] and [14.0 ± 2.0] cm/sec, P < 0.01; Em/Am ratio 0.53 ± 0.2 vs. 0.78 ± 0.19 and 0.8 ± 0.3 [P < 0.0001]). Among the intervals, there was significant prolongation of Q‐Em (558 ± 14.8 vs. 507 ± 16.2 and 480 ± 20 ms [P < 0.0001]) but Q‐Sm and Am were not statistically different between the groups. Conclusion: Right ventricular TDI diastolic parameters are abnormal in patients with RVMI. The method of recording the velocities and time intervals are simple and can be used to assess right ventricular diastolic function in patients with RVMI. (Echocardiography 2010;27:539‐543)     

右室梗塞11例的临床诊断与治疗

近几年来，由于右室梗塞（ＲｉｇｈｔＶｅｎｔｒｉｃｕｌａｌ·ＭｙｏｃａｒｄｉａｌＩｎｆａｒｃｔｉｏｎ，ＲＶＭＩ）的死亡率逐渐增高，且其早期并发症以及治疗预后方面不同于单纯的左室梗塞，因而对ＲＶＭＩ的早期诊断和及时治疗已越来越引起国内外医学界的重视。本文从１９８９年１月至１９９４年１月间确诊的１１例患者中，通过对临床诊断和治疗的分析，认为：大部分病例应用非侵入性方法（病史、体征、心电图等）诊断ＲＶＭ是完全可以的，既能减少病人痛苦，又能与血液动力学等侵入检查法取得同样效果。本文１１例心电图诊断基本符合国外文献报道。对ＲＶＭＩ的治疗，我们认为采取输液扩容是主要的治疗方法，同时也是首选疗法。