USEFULNESS OF PULMONARY REGURGITATION DOPPLER TRACINGS IN PREDICTING IN-HOSPITAL AND LONG-TERM OUTCOME IN PATIENTS WITH INFERIOR WALL ACUTEMYOCARDIAL-INFARCTION

Right ventricular (RV) involvement is frequent during inferior wall ac ute myocardial infarction (AMI) and has been reported as a risk factor for in-hospital morbidity and mortality. The objectives of the presen t study were: (1) to evaluate in-hospital events in patients with and without RV involvement as diagnosed by abnormal flow characteristics d erived from pulmonary regurgitation (PR) analysis (pressure half-time of PR, PHTPR less than or equal to 150 ms and the lowest mid-diastolic to peak early diastolic velocity ratio, V-min/V-max less than or equa l to 0.5); and (2) to determine the influence of RV involvement in com plications at longterm follow-up. Among 126 consecutively admitted pat ients with inferior wall AMI (mean age, 58 +/- 13 years), 101 had PR. We determined the prognostic significance of in-hospital and long-term events for the following variables: age greater than or equal to 65 y ears, ST-segment elevation greater than or equal to 1 mm in lead V-4R, RV dilation, PHT of PR less than or equal to 150 ms and V-min/ V-max less than or equal to 0.5, thrombolytic therapy, 3-vessel disease, and diabetes mellitus. We found that the PR derived Doppler index (PHT of PR less than or equal to 150 ms and V-min/V-max less than or equal to 0.5) was the only predictor of overall in-hospital clinical events (h azards ratio, 2.7, 95% confidence interval, 1.2 to 6.1, p = 0.016). At long-term follow-up (mean: 20 +/- 12 months, range 12 to 69), event-f ree survival analysis showed that age greater than or equal to 65 year s was the only predictor of any event (relative risk, 3.7, 95% confide nce interval, 2.1 to 6.3, p < 0.0001). Thus, RV involvement diagnosed with the use of PR flow-derived variables is an accurate and independe nt predictor of in-hospital complications. However, RV involvement doe s not influence long-term prognosis. (C) 1998 by Excerpta Medica, Inc.