Key result
Reduced TAPSE predicts proximal RCA occlusion with ~92% sensitivity in acute inferior MI.
Why the study?
Assessment of right ventricular function by echocardiographic parameters to predict proximal RCA stenosis and identify higher-risk patients in acute inferior wall myocardial infarction was needed.
Do echocardiographic parameters (TAPSE, S' velocity, MPI) accurately predict proximal RCA occlusion in patients with acute inferior wall myocardial ST-elevation infarction?
Cross-Sectional (n=67)
No
Do echocardiographic parameters (TAPSE, S' velocity, MPI) accurately predict proximal RCA occlusion in patients with acute inferior wall myocardial ST-elevation infarction?
Effect estimate: Sensitivity 92.0%, Specificity 90.5%
Absolute Event Rate: 92% vs 90.5%
p-value: p=0.0001
Simple echocardiographic parameters of right ventricular function like TAPSE and S' by TDI can effectively identify patients with proximal RCA occlusion in inferior wall myocardial infarction.
Echocardiographic RV indices may predict proximal RCA occlusion in inferior MI; hypothesis-generating and requires prospective validation before guiding management.
Objectives Assessment of RV function to predict proximal RCA stenosis and identification of higher-risk patients in IWMI by echocardiographic parameters. Study design Two-arm, single-center cross-sectional study in SMS medical college and Hospital Jaipur. Methods We enrolled 67 patients with first episode of acute IWMI within 24 hours of symptom onset. TAPSE, S’, and MPI were measured. Within one month, patients underwent coronary angiogram or intervention. Based on angiographic findings patients divided into group A (significant proximal RCA stenosis) and group B (without significant proximal RCA stenosis). Results 25 patients were in group A and 42 in group B. RV involvement was significant among patients with proximal RCA stenosis. A significantly low SBP, DBP, HR, and raised JVP, NT-pro BNP, Troponin I with ST elevation V4R, RV diastolic dysfunction, arrhythmia, and underwent intervention were found among the group with proximal RCA stenosis. Patients with proximal RCA stenosis had significantly low TAPSE-M, ET-PW, ET by TDI, S’, E’, RVFAC, and high MPI by PW, IRT by TDI, ICT by TDI, MPI by TDI on ECHO. Sensitivity to detect proximal RCA stenosis by TAPSE-M mode 92%, MPI by TDI 88%, and 100% specificity by S’ by TDI < 10 cm/s, MPI by TDI, and ST elevation V4R. Conclusion Echocardiographic assessment of RV parameters like TAPSE, S’ velocity, and MPI are useful in predicting proximal RCA as infarct-related artery in IWMI. Patients with proximal RCA stenosis had raised JVP, NT-proBNP, Troponin I, ST elevation V4R, RV diastolic dysfunction, arrhythmia and underwent intervention.
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Kumar et al. (2023) conducted a cross-sectional in Acute inferior wall myocardial ST elevation infarction (IWMI) (n=67). Echocardiographic parameters (TAPSE, S' velocity, and MPI) vs. Standard coronary angiography (reference standard) was evaluated on Prediction of proximal right coronary artery (RCA) stenosis using TAPSE M-mode (<1.7 cm) (Sensitivity 92.0%, Specificity 90.5%, p=0.0001). Echocardiographic parameters, notably TAPSE M-mode <1.7cm (92% sensitivity, 90.5% specificity) and tissue Doppler MPI (88% sensitivity, 100% specificity), accurately predicted proximal right coronary artery occlusion in acute inferior wall myocardial infarction.
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