Right ventricular infarction and tissue doppler imaging: Insights from acute inferior myocardial infarction after primary coronary intervention

Background: Tissue Doppler imaging (TDI) data for acute inferior myocardial infarction (MI) patients who have received primary percutaneous coronary intervention (PCI) are sparse. Methods and Results: One hundred and sixty-five patients received primary PCI for acute inferior MI were enrolled. Right ventricular infarction (RVI) was defined as a culprit lesion proximal to the right ventricular branch of right coronary artery (RCA). Echocardiograms and TDI were obtained within 6 h after primary PCI. The prevalence of multi-vessel disease in the RCA-P culprit group (50%) was higher than that in other groups (39% of RCA-D culprit, 43% of left circumflex artery (LCX) culprit). The myocardial performance index (MPI) of the lateral tricuspid annulus provides discriminatory power for identifying RVI, whereas systolic velocity (Sm) of the lateral tricuspid annulus does not. Lateral mitral annular MPI divided by the lateral tricuspid annular MPI is a reliable index for identifying a culprit lesion (>1.06 predicts culprit over LCX; <0.96 predicts culprit over RCA-P and RVI). Kaplan-Meier survival curves revealed that late cardiovascular events were more likely in RVI patients. However, multivariate Cox proportional hazards analysis revealed that the most important factor in hard events and all cardiovascular events was multivessel disease. Conclusions: TDI is useful for identifying RVI and culprit lesions in inferior MI patients received primary PCI. RVI itself isn't associated with 1-year hard events and all cardiovascular events.