CLINICAL AND DOPPLER-ECHOCARDIOGRAPHIC OU TCOME OF ISCHEMIC RIGHT-VENTRICULAR DYSFUNCTION ASSOCIATED WITH INFERIOR WALL INFARCTION

Right ventricular involvement during inferior wall myocardial infarcti on does not seem to alter long-term clinical prognosis but its specifi c outcome has not been clearly studied. We have previously demonstrate d that pulmonary regurgitant (PR) flow tracings doppler analysis allow s the accurate diagnosis of RV involvement, especially when the pressu re half-time of PR was less than or equal to 150 ms and the ratio of t he minimal velocity to the maximal velocity was less than or equal to 0,5. We studied 40 patients with acute inferior wall myocardial infarc tion and with PR flow. Doppler echocardiography was obtained during th e first day, before discharge (early control) and between 12 and 24 mo nths follow-up (late control). Among 22 patients with RV involvement d efined with PR-derived doppler parameters (RVI(PR)), 8 had right ventr icular enlargement and/or wall motion abnormalities, observed In 6 cas es at early control and in 4 at late control. Doppler analysis showed remnant RVI(PR) parameters in 9 patients at early control and 8 among these at late control, with no relation with pulmonary artery pressure or other echocardiographic parameters. No clinical, angiographic or t herapeutic data predicted these distinct echocardiographic and doppler patterns and the long-term prognosis was not different. At late contr ol, among 12 RVI(PR) patients which PR-derived doppler parameters were normal at early control, two patients had still RVI(PR) pattern at la te control and described ischemic recurrence. PR flow doppler analysis is a useful tool for diagnosis and outcome evaluation Of RV involveme nt and shows a remnant diastolic dysfunction in half of the patients w ith acute RV involvement.