Echocardiographic Evaluation Of Right Heart Function In Patients With Heart Failure After Myocardial Infarction

Objective: To investigate right heart function in patients with heart failure aftermyocardial infarction by M-mode echocardiography, tissue doppler imaging (TDI),single cardiac cycle of real-time three-dimensional echocardiography (sRT-3DE), anddefine their sensitivity and the superiority. To analysis the relation of the severity ofright heart function with left heart function, recognize the clinical value of right heartfunction in patients with heart failure after myocardial infarction.Methods:30cases of healthy adults were enrolled as normal control group, with noheart and lung diseases and other systemic diseases by the physical examinations aselectrocardiogram, chest radiograph, echocardiography and laboratory tests.60patientswere enrolled with heart failure after myocardial infarction, confirmed by coronaryangiography and echocardiography, and divided them into three groups. All patientswere sinus rhythm. Patients with any congenital heart diseases, valve implement andpulmonary heart disease related to right heart implement and poor image quality wereexcluded. Left ventricular ejection fraction (LVEF) parameters were measured byACUSON SC2000echocardiogram with the software of LVA automatic quantitativeanalysis at the status of three-dimensional echocardiography. According to LVEFmeasured by the three dimensional echocardiography,60patients were divided intothree groups. All the patients received echocardiography examinations. M-modeechocardiography indice included TAPSE of right ventricular free wall. TDI indicesincluded Tei index of interventricular septum and right ventricular free wall. Rightventricular volume parameters included right ventricular end-diastolic volume, rightventricular end-systolic volume, right ventricular stroke volume and ejection fraction(RVEDV, RVESV, RVSV, RVEF), and were measured by RT-3DE. We measured theparameters related to right ventricular function above to find the correlation of RVEF with LVEF.All Parameters were statistical analyzed with comparison research.Results: Comparing with normal control group, TAPSE in group A, group B, group Call had significant differences (P <0.05) and group C was significant differences (P <0.01) when compared withAgroup and B group. Comparing with normal control group,interventricular septum Tei index in group A, group B, group C all had significantdifferences (P <0.05), and group C was significant differences (P <0.01) Comparedwith group A and group B. Comparing with the normal control group, right ventricularfree wall Tei index in group A, group B, showed no significant statistical differences(P>0.05) while group C showed significant difference(P<0.05); C group had nosignificant statistical differences comparing with group B(P>0.05). As parameters ofthe right heart function as RVEDV, RVESV, RVSV, RVEF measured bythree-dimensional echocardiography, group C showed significant difference(P <0.01)comparing with normal group, group A and group B. Paired-comparison between RVEF,there was no statistically significant difference (P>0.05)between group B and group A;Group B showed significant difference (P <0.05) with normal group; Group A showedno significant difference (P>0.05) with normal group. Group C (LVEF <30%) inpatients with LVEF less than30%after myocardial infarction showed significant rightventricular expansion and right heart function damage(RVEF=34.12%±34.12%) bysRT-3DE. There was a positive correlation between LVEF and RVEF measured bysRT-3DE(r=0.866, P <0.01).Conclusion: Right heart function was impaired in different level, which could bemeasured both by traditional echocardiography and sRT-3DE in patients with heartfailure after myocardial infarction. LVEF <30%can lead to right heart dysfunction.And sRT-3DE has its unique advantage to evaluate right ventricular function.