The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: transesophageal echocardiographic examination.
BACKGROUND
The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental.


OBJECTIVE
The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables.


METHODS
Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow-up was continued from hospitalization to the present.


RESULTS
When patients with right atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was more prolonged in this group, and there was a higher incidence of arrhythmias, complete atrioventricular block, and mortality.


CONCLUSIONS
Right atrial ischemia associated with RV infarction leads to a higher incidence of complications and higher mortality. Transesophageal echocardiography is a safe, reproducible technique that provides detailed anatomic information about right chambers and aids in the determination of prognosis and therapeutic decisions.
Vargas-Barrón
Jesus
J
Department of Echocardiography, Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City, Mexico. eco_vargas@terra.com.mx
López-Meneses
Mauricio
M
Roldán
Francisco-Javier
FJ
Romero-Cárdenas
Angel
A
Keirns
Candace
C
Espinola-Zavaleta
Nilda
N
Peña-Duque
Marco
M
Martínez-Sánchez
Carlos
C
Martinez Ríos
Marco-Antonio
MA
D000328:Adult; D000368:Aged; D016280:Atrial Function, Right; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging