Speckle tracking echocardiography with a 12 segment model approach of the right ventricle might identify better right ventricular dysfunction in coronary artery disease

Introduction: Right ventricular (RV) dysfunction is associated with increased mortality in patients with acute or chronic coronary artery disease (CAD). Conventional echo parameters may not identify always RV dysfunction, since they ignore the contribution of some RV walls to ejection. MRI studies suggested that tricuspid annular systolic velocity (S’) might be a better marker of RV dysfunction, but they included only the 4C view evaluation. Speckle tracking echocardiography (STE), by assessing the RV as a whole, might be a better technique for the diagnosis of RV dysfunction. Thus, we investigated the role of a new12 segment model of the RV in the detection of the RV dysfunction by STE, in patients with acute or chronic CAD.  Methods: We studied 95 subjects: 45 with acute myocardial infarction (AMI) and right coronary artery occlusion, evaluated 48 h aft er primary PCI, 25 with severe, chronic, surgical CAD, after elective coronarography, and 25 normals (with similar age and sex). RV dysfunction was diagnosed by conventional echo, from tricuspid annular systolic excursion (TAPSE) and fractional area change (FAC), being defined by TAPSE < 16mm and FAC < 32%; by tissue Doppler from S’, being defined by a S’ < 11 cm/s; and by STE, from lateral (LS) and septal (SS) strain (4C view), and from anterior (AS) and inferior (IS) strain (2C view), global RVs train (RVGS) being calculated. Results: RV dysfunction was diagnosed by conventional echo in 34%, by tissue Doppler in 54%, and by all 3 parameters in 57% of CAD patients. However, in the remained 43% patients: acute CAD (n = 19) and chronic CAD (n = 11), labeled with “no RV dysfunction”, we found decreased all deformation parameters by comparison with normals, with no differences between acute and chronic CAD. LS: -19 ± 7 vs -22 ± 6 vs -28 ± 5; SS: -14 ± 6 vs -12 ± 6 vs -20 ± 3; 4CGS: -16 ± 5 vs-17 ± 4 vs -24 ± 3; AS: -19 ± 7vs-20 ± 7 vs-28 ± 4; IS: -21 ± 8 vs -23 ± 7 vs -30 ± 3; 2C GS: -20 ± 6 vs -21 ± 6 vs -29 ± 3; RVGS: -18 ± 5 vs -19 ± 4 vs -26 ± 2 (all p < 0.001). Conclusions: Speckle tracking echocardiography with a 12 segment model approach of the right ventricle might identify better right ventricular dysfunction in patients with acute or chronic CAD. Further studies are needed to establish cut-off values, and provide accuracy and prognostic value of this new approach.

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