TAPSE, Tissue Doppler Systolic annular velocity(S’) and myocardial performance Index (MPI) as a predictor of proximal RCA occlusion in acute inferior wall myocardial ST elevation infarction

Abstract

AbstractObjectivesAssessment of RV function to predict proximal RCA stenosis and identification of higher-risk patients in IWMI by echocardiographic parameters.Study designTwo-arm, single-center cross-sectional study in SMS medical college and Hospital Jaipur.MethodsWe 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).Results25 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.ConclusionEchocardiographic 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.