Evaluate Right Ventricular Systolic Function In The Patients With Acute Inferior Myocardial Infraction In Associate With Right Ventricular Myocardial Infraction By Three-plane Speckle Tracking Imaging

Objective:To evaluate the clinical value of right ventricular systolic function in the patients with acute inferior myocardial infraction in associate with right ventricular myocardial infraction by three-plane speckle tracking imaging?3P-STI?.Methods:33 patients were diagnosed with acute inferior myocardial infration in our hospital from August 2016 to December 2017.19 patients with isolated acute inferior myocardial infarction were served as INFMI group;14 patients with acute inferior myocardial infarction in associate with right ventricular myocardial infarction were served as RVMI group.In INFMI group,13 males and 6 females,mean age 64.2±11.0 years;In RVMI group,7 males and 7 females,mean age 59.1±12.6 years.RVMI group and INFMI group in this article were called as Acute Myocardial Infarction?AMI?group.All patients with STEMI diagnostic criteria:a history of typically chest pain,chest distress,serum myocardial injury markers and ECG showed ST-segment elevation.The ECG showed infarction graphics changes at limb lead II,III,aVF lead ST-segment elevation of more than 1 mm in at least 2-3 inferior leads and typical increase in cardiac enzymes and the ST-segment elevation of?0.1mV in the right precordial leads,especially V₄R is readily available electrocardiographic sign for diagnosis of right ventricular infarction.During the time,21 patients with suspected CAD who underwent elective coronary angiography,but the results were negative were served as control group,including 8 males and 13females,mean age 59.8±10.8 years.Exclusion criteria:patients with prior inferior myocardial infarction;patients with acute myocardial infarction who had been treated with percutaneous coronary intervention?PCI?or acute thrombolysis;patients with heart valve disease;patients with arrhythmogenic right ventricular cardiomyopathy;pulmonary vascular disease;pericardial disease;arrhythmia;patients with right heart dysfunction and abnormal right ventricular wall motion;patients with poor echocardiographic images that cannot be annlyed.All the subjects underwent conventional echocardiography and 3P-STI for right ventricular within 2 days.All patients underwent transthoracic echocardiography with a commercially available cardiovascularultrasoundsystem?vividE9,GEHealthcare,Vingmed,Norway?,equipped with Echo PAC?BT113?workstation.Two-Dimensional Echocardiography parameters:Left ventricular end diastolic volume?LVEDV?,Left ventricular end systolic volume?LVESV?,Left ventricular ejection fraction?LVEF?measured by biplane Simpsion method,Tricuspid annular plane systolic excursion?TAPSE?,Right ventricular Tricuspid annulus peak systolic velocity?S'?.Longitudinal 2D strain was measured by three plane speckle tracking in all three apical RV views including the apical,mid and basal segments of the right ventricular free wall and the interventricular septum.RV 2D strain measurements were averaged for all 18 segments,9 for the RV free wall and 9 for the interventricularseptum.Then,threegroupsdatawerecomparedand analyzed.Receiver Operating Characteristic curves?ROC?of RVMI were predicted by TAPSE,RV S'and RV two-dimensional longitudinal strain parameters,the area under the curve?AUC?,the predicted cut-off value of each parameter and corresponding sensitivity and specificity were obtained.Results:1.Compared to the control group,the right ventricular global longitudinal strain?RVGLS?,the longitudinal strain of basal and middle segment of interventricular septum,the longitudinal strain of basal segment,middle and apical segment of RV free wall were decreased in AMI group,the difference was statistically significant?P<0.05?;2.Compared to the control group,the right ventricular global longitudinal strain?RVGLS?,the longitudinal strain of RV free wall and the apical segment of interventricular septum were decresed in the RVMI group,the difference was statistically significant?P<0.05?;3.Compared to the INFMI group,the right ventricular global longitudinal strain?RVGLS?,the longitudinal strain of the middle and apical segment of RV free wallwerelowerinRVMIgroup,thedifferencewasstatistically significant?P<0.05??P<0.05?.4.ROC curve analysis showed that the right ventricular global longitudinal strain?RVGLS?and right ventricular free wall strain?RVFWLS?had a higher diagnostic value than others parameters.The cut-off value of RVFWLS was-18.32%?sensitivity 90.1%,specificity of 82.6%?,RVGLS diagnostic cut-off value of-17.46%?sensitivity 89.3%,specificity of 83.5%?.Conclusion:3P-STI can noninvasive and accurately analyze the right ventricular systolic function in the patients with RVMI and INFMI.