Title: In Hospital Outcome of Subclinical Right Ventricular Involvement in Patients with Acute Inferior Myocardial Infarction
Authors: Ahmad B. Elden, Mahmoud Ashry, Refaat Fathy
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.54
Patients and Methods: We conducted a short prospective study carried out on 60 patients with acute inferior myocardial infarction, classified into two groups; patients group: AIMI with ScRVI; inferior or infroposterior acute myocardial infarction (AMI)patients with ≥ 0.1 mV V4R elevation, and control group: AIMI without ScRVI; inferior or infroposterior AMI patients without ≥ 0.1 mV V4R elevation. We followed up both groups during their hospital stay and compared both groups regarding development of complications and mortality. Results: Patients with ScRVI in AIMI had more admission hyperglycaemia (268.80 ± 81.88 mg/dl vs. 219.80 ± 98.40 mg/dl, P value =0.003), less incidence of complete ST elevation resolution (STR) (60.8 %vs. 80.6%, p value = 0.032), more arrhythmic complications (3rd heart block [HB]: 6.7% vs. 0.0%, p value = 0.042, atrial fibrillation [AF]: 10.0% vs. 2.0%, p value = 0.036). Conclusions: We concluded that patients with ScRVI in AIMI had worse in hospital outcome than patients without ScRVI. Keywords: Subclinical Right Ventricular Involvement, Acute Inferior Myocardial Infarction. 1. Stanley George, Mansi Patel and Ashok Thakkar (2014):Clinical Profile and In-Hospital Outcome of Patients with Right Ventricular Myocardial Infarction. International Journal of Clinical Medicine; 5, 459-63. 2. Haji, S.A. and Movahed, A. (2000):Right Ventricular Infarction—Diagnosis and Treatment. Clinical Cardiology, 23,473-482. 3. Mehta, S.R., Eikelboom, J.W., Natarajan, M.K., Diaz, R., Yi, C., Gibbons, R.J. and Yusuf, S. (2001)Impact of Right Ventricular Involvement on Mortality and Morbidity in Patients with Inferior Myocardial Infarction. Journal of the American College of Cardiology,37,37-43. 4. Elliott M. A, Daniel T. Anbe and Frederick G. Kushner et al. (2004): ACC/ AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Developed in Collaboration With the Canadian Cardiovascular Society. American College of Cardiology Web Site(www.cardiosource.org/acc). 5. Schröder K, Wegscheider K and Zeymer U et al. (2001): Extent of ST-segment deviation in the single ECG lead of maximum deviation present 90 or 180 minutes after start of thrombolytic therapy best predicts outcome in acute myocardial infarction. Zeitschrift für Kardiologie; 90:557–67. 6. Elliott M. A, Hand M and Armstrong P. W et al. (2008): 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/ American Heart Association task force on practice guidelines. Circulation; 117(2): 296–329. 7. Manuel D. Cerqueira, Neil J. Weissman and Vasken Dilsizian et al. (2002): Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart. American Heart Association, Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. Circulation; 105:539-42 8. Capes SE, Hunt D and Malmberg K et al. (2000): Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet; 356: 773–8. 9. Oliver M. F and Opie L. H. (1994): Effects of glucose and fatty acids on myocardial ischemia and arrhythmias. The Lancet; 343(8890):155–58. 10. Umpierrez GE and A.E.K. (2004): ICU care for patients with diabetes. Current Opinion in Endocrinology and Diabetes; 11: 75–81. 11. Bolognese L, Carrabba N and Parodi G et al. (2004): Impact of microvascular dysfunction on left ventricular remodelling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation; 109: 1121–6. 12. Angeja BG, Gunda M and Murphy SA et al. (2002): TAIMI myocardial perfusion grade and ST segment resolution: association with infarct size as assessed by single photon emission computed tomog-raphy imaging. Circulation; 105:282–5. 13. Brosh D, Assali AR and Mager A et al. (2007): Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. American Journal of Cardiology; 99:442–5. 14. Bolognese L, Carrabba N and Parodi G et al. (2004): Impact of microvascular dysfunction on left ventricular remodelling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation; 109:1121–6. 15. Niccoli G, Burzotta F and Galiuto L et al. (2009): Myocardial no-reflow in humans. Journal of the American College of Cardiology; 54:281–92. 16. Mehta SR, Eikelboom JW and Natarajan MKet al. (2001):Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. Journal of the American College of Cardiology;37:37-43. 17. Barrillon A, Chaignon M, Guize L and Gerbaux A (1975):Premonitory sign of heart block in acute posterior myocardial infarction. British Heart Journal;37:2-8. 18. Zehender M, Kasper W and Kauder Eet al. (1993):Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. Abstract
References