Lupi-Herrera E, Jativa-Chávez SM, Soto ME, Hernández-Gutiérrez K, Espínola-Zavaleta N

Language: English
References: 10
Page: 51-55
PDF size: 174.12 Kb.

ABSTRACT

Introduction: Contrast echocardiography (CE) is an important diagnostic tool for routine clinical use in the assessment of the patient with acute coronary syndrome (ACS). Its utility in elucidating the functional status of the right ventricle (RV), is hypothesized to be of use when evaluating the prognosis and hence the need for a prompt intervention. Used in the setting of an ACS, CE can predict which patients are likely to have proximal obstruction of right coronary artery (RCA). Based on that premise, when the clinical suspicion of proximal RCA obstruction is suspected, we can confidently proceed to an earlier intervention. The aim of the study was to determine if the magnitude of the RV perfusion defects correlates with the stenosis site of RCA. Methods and results: We studied 24 patients with ACS, in which a CE was performed previous to a coronary angiography. A statistical correlation was made to demonstrate the severity of the obstruction in terms of location; with the walls affected, seen with CE. A direct correlation was found when more than two walls were involved. Those patients had proximal RCA obstructions, and therefore a worse prognosis. Conclusion: There is a good correlation between the magnitude of the perfusion defect observed by CE and the stenosis site of the responsible coronary artery.

REFERENCES

1. Bowers TR et al. Patterns of coronary compromise resulting in acute right ventricular ischemic dysfunction. Circulation. 2002; 106: 1104-1109.

2. Shiraki H, Yoshikawa T, Anzai T et al. Association between preinfarction angina and a lower risk of right ventricular infarction. N Engl J Med. 1998; 338 (14): 941-947.

3. Goldstein JA, Tweddell JS, Barzilai B et al. Importance of left ventricular function and systolic interaction to right ventricular performance during acute right heart ischemia. J Am Coll Cardiol. 1999; 18: 1564-1572.

4. Borrayo G et al. Valoración de la función ventricular derecha mediante ecocardiografía de contraste en pacientes con infarto agudo de miocardio. Rev Esp Cardiol. 2003; 56: 175-180.

5. Tei C, Sakamaki T, Shah P. Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion defects. Circulation. 1983; 67: 585-593.

6. Fernández J, García M, Moreno M et al. Utilidad de las nuevas técnicas de imagen, segundo armónico y contraste en la visualización del borde endocárdico. Análisis de la reproducibilidad en la valoración de la contracción segmentaria. Rev Esp Cardiol. 2000; 53: 1459-1466.

7. Steven B, Lasterm SB, Shelton TJ et al. Determinants of the recovery of right ventricular performance following experimental chronic right coronary artery occlusion. Circulation. 1993; 88: 696-708.

8. Jacobs AK, Leopold JA, Bates E et al. Cardiogenic shock caused by right ventricular infarction. J Am Coll Cardiol. 2003; 41: 1273-1279.

9. Zeymer U, Neuhaus KL, Wescheider K et al. Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement. J Am Coll Cardiol. 1998; 32: 876-881.

10. Lepper W, Kamp O, Vanoverschelde JL et al. Intravenous myocardial contrast echocardiography predicts let ventricular remodeling in patients with acute myocardial infarction. J Am Soc Echocardiogr. 2002; 15: 849-856.