Right Ventricular Dysfunction in Patients with Acute STEMI, Radionuclide-Based Assessment

Background: An acute myocardial infarction, particularly one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle. Cardiac remodeling after acute myocardial infarction (AMI) is characterized by molecular and cellular mechanisms involving both left and right ventricles. Objective: To study the right ventricular affection in patients with acute myocardial infarction of the left ventricle and treated with primary PCI. Methods: The study was done in the critical care department, Cairo University (in which 2,500 primary percutaneous coronary interventions (PCIs) are done annually). Forty patients with acute ST-elevation myocardial infarction (STEMI) were subjected to primary (PCI), we excluded all patients with RV infarction and patients with pulmonary hypertension. RV function was assessed by first pass radionuclide angiocardiography within 48 hours of admission. Results: Regarding the incidence of right ventricular dysfunction in patients with acute left ventricular STEMI who treated with 1ry PCI, there were 21 patients (52.5%) with RV EF% patients (47.5%) with RV time to peak filling rate (TPFR) > 180 msec. There was a significant relationship between right ventricular dysfunction and duration of ICU stay, impairment of LV systolic function, failure of complete resolution of ST segment elevation, failure of early peaking of cardiac enzymes, occurrence of in-hospital complications and one year mortality. Conclusion: The incidence of right ventricular dysfunction in patients with acute left ventricular STEMI is higher than expected and has a negative impact on their outcome.