Evaluation of Combined Systolic Excursion with Echocardiographic M-Mode and Angiographic Correlation with Severe Proximal Stenosis of the Right Coronary Artery in Patients Presenting with Acute Inferior Myocardial Infarction

Abstract

Aim: Right ventricular (RV) involvement, which is found frequently in proximally located right coronary artery (RCA) lesions, is observed in one-third of patients with inferior wall myocardial infarction (IWMI). RV involvement is significant in terms of mortality and future complications. We aimed to examine the relationship between RV function and the RCA occlusion site in these patients using a new echocardiographic parameter, combined systolic excursion (CSE). Material and Methods: Thirty-three adult patients (21 males, 64%) diagnosed with IWMI with the culprit lesion in the RCA were included. The study population was divided into two groups: those with proximal RCA occlusion and those with non-proximal RCA occlusion. Findings were compared between the groups. Results: RV functions evaluated by echocardiography significantly differed between the two groups. In patients with proximal RCA occlusion, CSE, tricuspid annular plane systolic excursion (TAPSE), right ventricular outflow tract systolic excursion (RVOTSE), and RV lateral wall systolic velocity (S’) were significantly lower compared to the patients with non-proximal RCA occlusion (p values <0.05). In addition, a positive correlation was found between CSE and TAPSE, RVOT-SE, and S’values (p-values <0.05). According to the multivariate regression analysis, CSE and systolic blood pressure were independent predictors of proximally located RCA lesions (Odds Ratio [95% Confidence Interval], 32.05 [1.40– 729.84], p=0.030 and 1.10 [1.01–1.21], p=0.045, respectively). In Receiver Operating Characteristic (ROC) curve analysis, CSE with a cut-off value of 20.15 mm predicted proximally located RCA occlusion with 91.7% sensitivity and 76.2% specificity (p<0.001) Conclusion: CSE, together with TAPSE, RVOT-SE, and S’, was significantly associated with proximally localized RCA lesions and RV involvement in patients with IWMI. Further, CSE was an independent predictor of proximal RCA lesions. Using CSE could be a more accurate parameter in detecting RV involvement in these patients.

Keywords

• inferior myocardial infarction
• right coronary artery
• echocardiography
• right ventricular function; combined systolic excursion

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