Correlation of Right Ventricular Function With Morbidity and Mortality in Acute Inferior Wall Myocardial Infarction
TL;DR
RV dysfunction is clinically important in acute IWMI and is strongly associated with hemodynamic compromise, ECG markers, conduction abnormalities, and echocardiographic abnormalities, and routine assessment of RV function, particularly TAPSE and right-sided ECG leads, may improve early risk stratification and guide management.
Abstract
Background: Right ventricular (RV) dysfunction is an important determinant of hemodynamic instability and adverse outcomes in acute inferior wall myocardial infarction (IWMI), but its clinical significance may be underrecognized. This study evaluated the relationship of RV dysfunction with morbidity and in-hospital mortality in patients with acute IWMI. Methods: A retrospective observational study was conducted among 94 adults with first-time acute IWMI admitted within 24 hours of symptom onset at the Department of Cardiology, SRIHER, Chennai. Diagnosis was established by inferior ST-segment elevation and positive cardiac biomarkers. Transthoracic echocardiography was performed within 24-48 hours, and RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler S' velocity, and RV/LV basal diameter ratio. Clinical, electrocardiographic, echocardiographic, and in-hospital outcome data were analyzed using appropriate statistical tests; p < 0.05 was considered significant. Results: The mean age was 61.33 ± 11.36 years, with male predominance (69.1%). Dyslipidaemia (52.1%), hypertension (48.9%), and diabetes mellitus (45.7%) were common. Raised jugular venous pressure was present in 54.3%, ST-segment elevation in V4R in 53.2%, and atrioventricular block in 21.3%. Mean LVEF was 42.56 ± 8.60%, while mean TAPSE was 14.92 ± 3.44 mm. RV dysfunction was significantly associated with hypotension requiring inotropic support (χ² = 17.857, p < 0.0001), reduced TAPSE (χ² = 94.00, p < 0.0001), AV block (χ² = 7.680, p = 0.0056), V4R elevation (χ² = 32.292, p < 0.0001), raised JVP (χ² = 3.907, p = 0.0481), and increasing mitral regurgitation severity (χ² = 12.594, p = 0.0056). No significant association was observed with mechanical ventilation, hospital stay, or in-hospital mortality. Conclusion: RV dysfunction is clinically important in acute IWMI and is strongly associated with hemodynamic compromise, ECG markers, conduction abnormalities, and echocardiographic abnormalities. Routine assessment of RV function, particularly TAPSE and right-sided ECG leads, may improve early risk stratification and guide management. Early recognition may facilitate timely hemodynamic support, intensive monitoring, and comprehensive biventricular assessment.