Evaluation of combined systolic excursion with echocardiographic m-mode and angiographi̇c correlation with severe proximal stenosis of the right coronary artery in patients presenti̇ng with acute inferior myocardial infarction

Introduction and Aim: Right ventricular functions are affected in approximately one third of patients with inferior wall myocardial infarction (MI). Right ventricular (RV) involvement in patients with inferior wall MI has been identified as a strong predictor of in-hospital mortality and major complications, and studies using multiple echocardiographic assessment methods have been performed to define this risk. The most commonly used methods are fractional area change (FAC), systolic excursion (TAPSE) measured from the tricuspid anulus, systolic velocity (S') obtained by tissue doppler analysis of the tricuspid anulus, and myocardial performance index. Studies have shown that right ventricular outflow tract systolic excursion (RVOT-SE) has an important place in global right ventricular functions. In this study, we aimed to examine the correlation between the value of right ventricular combined systolic excursion (CSE) by summing TAPSE and RVOT-SE, and RCA proximal stenosis in patients presenting with inferior wall myocardial infarction. Materials and Methods: The study included 33 patients with inferior MI, 21 males and 12 females, over 18 years of age, with at least 1 mm ST segment elevation in the inferior leads on ECG at the onset of symptoms, and a sub-derivative of RCA occlusion detected by angiography. has been planned. With TAPSE, M mode, longitudinal RV anulus of the right ventricle parallel to the plane of the tricuspid ring and lateral wall. by measuring systolic range of motion and RVOT-SE was measured from magnified cine loops of the RVOT field obtained from the parasternal short axis view using M-Mode echocardiography. Results: There was no statistically significant difference between the two groups in terms of age, height, weight, body mass, and risk factors. In the group with proximal RCA stenosis, low SBP and DBP were found to be statistically significant (p<0.001 and p= 0.003). CSE, TAPSE, RVOT-SE, S' were significantly lower in those with proximal RCA occlusion (p<0.001). CSE was shown to predict proximal RCA stenosis with 91.7% sensitivity and 71.4% specificity. (AUC: 0.90 CI: 0.777-1,000, p<0.001). Conclusion: In our study, it was observed that the parameter we defined as right ventricular combined systolic excursion (CSE) was correlated with right coronary artery (RCA) proximal occlusion in patients presenting with acute inferior wall myocardial infarction. Our findings were that CSE was also correlated with other right ventricular systolic parameters. It has previously been shown that TAPSE and RVOT-SE values predict proximal RCA stenosis in patients with inferior wall myocardial infarction. However, right ventricular combined systolic excursion (CSE), which is a combination of TAPSE and RVOT-SE parameters, was defined for the first time in the literature in our study. CSE can be considered to be used in our daily practice as an echocardiographic parameter that will affect and guide the treatment of patients by predicting proximal RCA involvement and therefore right ventricular involvement before invasive intervention in patients presenting with acute inferior wall myocardial infarction.