Prospective Serial Echocardiographic Assessment of Right Ventricular Functional Recovery following Reperfusion Therapy in Inferior Wall Myocardial Infarction

Background: Right ventricular myocardial infarction (RVMI) complicates approximately one-third of inferior wall ST elevation myocardial infarction (IWMI) cases and substantially increases in-hospital morbidity and mortality. Despite its clinical significance, the trajectory and completeness of right ventricular functional recovery following reperfusion and the relative benefit of mechanical versus pharmacological revascularization remain incompletely characterized in Indian populations. Objective: This study aims to prospectively evaluate serial multiparametric echocardiographic (ECHO) recovery of right ventricular function following reperfusion therapy in Indian IWMI patients with right ventricular involvement. Materials and Methods: A prospective observational cohort of 100 patients with first-presentation IWMI and electrocardiogram-confirmed RVMI (ST elevation ≥ 1 mm in V4R) was enrolled at a tertiary care center over 12 months. Serial two-dimensional ECHO was performed at admission and at 1-month follow-up, guided by ASE/EACVI 2015 guidelines. RV morphological injury was graded using the Isner–Roberts classification (Grades I–IV). Reperfusion was achieved by primary percutaneous transluminal coronary angioplasty (PTCA, n = 72) or thrombolysis ( n = 28). Paired comparisons used the Student’s t -test or Wilcoxon signed–rank test as appropriate; categorical shifts were assessed using the Stuart–Maxwell test. Results: The cohort was predominantly male (77%), with a 94% of patients aged 40–80 years. At 1 month, Right ventricular (RV) ejection fraction improved significantly from 49.1% ±8.1% to 53.7% ±7.2% ( P < 0.01), and RV fractional area change increased from 39.0% ±7.4% to 44.3% ±7.7% ( P < 0.01). LV ejection fraction also improved (58.1% ±6.9% → 60.7% ±5.7%; P < 0.01), consistent with biventricular interdependence. Global RV performance (right ventricular myocardial performance index) decreased from 47.9 ± 9.1 to 44.6 ± 7.6 ( P < 0.01), and RV systolic pressure fell from 25.8 ± 5.5 to 24.7 ± 4.5 mmHg ( P < 0.01). Morphologically, high-grade infarction (Grade III) fell from 29% to 7%, and no patients remained at Grade IV at follow-up, while Grade I prevalence rose from 12% to 36% ( P < 0.01). PTCA was the only clinical variable that significantly correlated with improvement in RV morphological grade ( P = 0.042), outperforming thrombolysis. Tricuspid annular plane systolic excursion (TAPSE) improved significantly from 19.57 ± 4.78 mm to 20.72 ± 4.40 mm ( P < 0.01); the proportion of patients with normal TAPSE values increased from 77% to 85% ( P = 0.008). Despite reaching statistical significance, the absolute improvement was modest compared to other RV parameters, underscoring the need for a multiparametric ECHO approach. Conclusion: Timely reperfusion produces substantial and measurable right ventricular functional recovery within 1 month of IWMI complicated by RVMI, with morphological grade regression closely mirroring ECHO improvement. Patients undergoing PTCA demonstrated greater improvement in right ventricular functional parameters compared with thrombolysis alone in this cohort. A multiparametric ECHO approach is essential, as no single parameter, including TAPSE, adequately captures the full extent of early right ventricular functional restoration.