الفهرس 
List of ContentsOnly 14 pages are availabe for public view
 |  | from | 100 |  |  |
| | | from | 100 | | |
Abstract
Background : Atherosclerotic CAD is the main cause of death globally ; it had ranged from asymptomatic (silent) to acute coronary syndrome and even sudden cardiac death, in USA 900000 patients suffer from MI and 225000 of whom died annually. Existence of RVMI raises the possibility of development of shock, dysrhythmias well as death in inferior wall MI. Generally, obstruction of proximal RCA is responsible for RV infarction in inferior wall MI. There are few researches validating efficacy of different Echo parameters of RV functions in assessment of RV infarction as well as predicting proximal RCA occlusion. The majority of them evaluated only one parameter of RV function and multiple lacked angiographic correlations. In the current study, we aimed to evaluate whether ECHO evaluation of RV functions were helpful in prediction of proximal RCA occlusion and thus recognize a subset of inferior wall MI cases at higher possibility for complications. Traditional measurements of area and volume have restricted value in evaluating RV function owing to the complex geometry of RV. Many indices were emerged as substitutes reliant on the contraction of longitudinal fibers that shorten the long axis of RV and draw tricuspid annulus towards apex. Tissue Doppler indices including MPI have proven role in evaluation of global RV function. Patients and Methods : This was a cross- sectional observational study and performed on 54 consecutive patients who underwent coronary angiography who revealed totally occluded right coronary artery (RCA) at Cardiovascular Department, Faculty of Medicine, Mansoura University. Entire cases were further subdivided into three small subgroups according to the site of occlusion into : • Proximal RCA occlusion. • Mid RCA occlusion. • Distal RCA occlusion. Inclusion criteria : Any Patient who underwent Coronary angiography who revealed totally occluded RCA. Exclusion criteria : • Patients with Sever pulmonary hypertension (HTN). • Patient with chronic obstructive pulmonary disease. • Patient with congenital right ventricular dysplasia. • Patients with ventricular-paced rhythm. • Patients with severe valvular heart disease. • Investigations : Electrocardiogram : Standard 12- lead ECG was done to all patients using a paper speed of 25 mm/s and standardization of 1 mV/10 mm. Two- D conventional ECHO : Patients were imaged in the left lateral decubitus position using a commercially available system (Vivid 9, General Electric-Vingmed, Horton, Norway). Data acquisition was performed in the parasternal and apical views. Standard M-mode, 2D and Doppler images was obtained during breath hold and saved in cine-loop. Echocardiographic assessment of RV function : All two dimensional, M-mode and conventional Doppler echocardiographic measurements were performed according to guidelines of American Society of Echocardiography. All measurements were repeated thrice and mean values were taken. For assessment of RV function, the following parameters were used. Focusing on TAPSE, Tei, RV FAC by echocardiography. Results : RV function impaired in totally occluded Right coronary artery. Conclusion : In conclusion, MPI, TAPSE and RV FAC are considered as useful predictors for proximal RCA as infarct related artery. In addition, MPI might aid in the prediction of proximal Vs distal RCA stenosis. Recognizing this group of cases early in their presentation by utilizing an MPI value might aid in the initial evaluation as well as treatment of RVI and prognostic risk stratification for patients with RCA occlusion.