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  • Title: [M-mode echocardiographic study of right ventricular involvement in the acute phase of inferoposterior myocardial infarction].
    Author: Langella B, Daubert JC, de Place C, Dubreil Y, Descaves C, Gouffault J.
    Journal: Arch Mal Coeur Vaiss; 1983 Sep; 76(9):979-90. PubMed ID: 6416215.
    Abstract:
    The aim of this study was to assess the value of a non-invasive technique, echocardiography, in diagnosing RV extension during the acute phase of myocardial infarction. Forty patients with an acute infero-posterior infarct were divided into two groups according to the presence (Group A) or absence (Group B) of RV akinesia on angiography. M mode echocardiography was carried out from two positions: left parasternal, for the study of quantitative parameters: RV and LV diameters, wall thickness and excursion, VCF and fractional shortening, mitral and tricuspid valve morphology, aortic and left atrial dimensions; subxostal: for the study of one parametere: RV inferior wall motion assessed as normal or akinetic. A comparative statistical study including a group of 35 controls was carried out. The results showed at comparable values in both groups, that patients in Group A had lower global LV function, hypokinesia of the LV posterior wall with minor changes in the mitral valve echo and LA dimension; akinesia of the RV inferior wall, a direct and specific sign of RV infarction, was observed in 50 p. 100 of cases; in comparison with the other two groups, despite large individual variations, there was a significant increase in RV diameter (p less than 0,001) and RV/LV diameter (p less than 0,001), and in the amplitude of systolic motion of the RV anterior wall (p less than 0,05 and p less than 0,01). Other qualitative signs were inconstant: paradoxical septal motion (7/20), pericardial separation (3/20), tricuspid B point (5/20). Dilatation of the RV was inconstant (50 p. 100 of cases) but its association with paradoxical septal motion was indicative of significant tricuspid incompetence. Akinesia of the RV inferior wall seemed to be of prognostic value: RVEDP and the extent of angiographic RV akinesia were greater in its presence (p less than 0,05). There was a slight correlation between RV dimensions (RV diameter and RV/LV diameters) and the extent of angiographic RV akinesia (R = 0,50, p less than 0,05) and with cardiac index (R = 0,60, p less than 0,05). This study shows that M mode echo provides positive direct signs of RV infarction in about 50 p. 100 of cases. The sensitivity of the technique is therefore relatively low. However, it does distinguish the more severe forms of biventricular infarction, especially when complicated by tricuspid incompetence.
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