الفهرس 
Diagnostic And Predictive Value Of Right Ventricular Strain In Batiants With (Nstemi) Left Ventricular Non St Elevation Myocardial Infarction
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Abstract
Myocardial strain analysis, which describes myocardial deformation (shortening or lengthening), provides more detailed information about right ventricular (RV) functions than conventional echocardiography and delivers prognostic information.
Objective: To assess the diagnostic and predictive value of RV strain in detecting RV subtle changes in the right ventricle that could occur after left ventricular infarction (NSTEMI) using 2D speckle tracking technique.
Subjects: Forty eight subjects who were admitted at Cardiology Department in Kasr Al Ainy Cairo University hospitals with acute non ST-elevation myocardial infarction (NSTEMI) and successfully managed in the hospital from September 2021 to April 2022 were recruited to the study (NSTEMI group). These Patients were sub-divided according to the RV function based on RVGLS and RVFWS into 2 groups: Normal RV strain < -20%, Abnormal RV strain ≥ -20%. NSTEMI patients were compared with 37 age and sex matched healthy subjects (Control group).
Methods: After written informed consent, subjects underwent detailed clinical history, clinical examination, routine laboratory investigations, lipid profile and cardiac biomarkers. Conventional 2D-TTE (Two-dimensional transthoracic echocardiography) in addition to RV 2D-STE (Speckle Tracking Echocardiography) were performed to all study subjects, and for patients on admission to the hospital after stabilizing their condition and before discharge. Statistical methods: Data were analyzed using IBM SPSS software package version 20.0. P values ≤ 0.05 were considered as statistically significant.
Results: EF and TAPSE were significantly lower among NSTEMI group when compared with controls (p=0.001 for both). LVEDD, EDV, ESV, Aorta and PASP were significantly higher among NSTEMI group when compared with controls (p=0.029, 0.001, <0.001, 0.001, and <0.001 respectively). RVFWS was significantly higher among NSTEMI group when compared with controls (p<0.001). Incidence of abnormal RV GLS was significantly higher among NSTEMI group (p<0.001). Among NSTEMI patients, 72.9% showed non ST elevation ECG changes. Single vessel occlusion was reported in (58.3%) of patients. Among all the risk factors, smoking was the most prevalent among the 2 subgroup, but none showed any statistically significant difference. Patients with multi-vessel affection as well as those who needed >1 stent showed a statistically significant abnormal RVGLS (≥-20), (p=0.033 and 0.011 respectively). Uni-variate regression analysis revealed that RVFWS and basal RV dimension showed a strong positive correlation with abnormality in RVGLS (p=0.007 and 0.024 respectively, odds ratio 3.49 and 13.46 respectively). Regarding the PCI findings, there was a positive correlation between the RV strain impairment and multiple vessels occlusion and more than 1 stent application (p=0.045 and 0.02 respectively and odd ratio 5.33 and 7.0 respectively). In multivariate analysis revealed RV free wall strain as the strongest predictor for RV dysfunction in NSTEMI patients (p=0.026, odd ratio 4.428). Multivariate analysis to impaired RVFWS showed that EF and dilated basal RV dimensions were the strongest predictors for RV dysfunction.
Conclusion: Assessing the right ventricular function using right ventricular global longitudinal strain is a sensitive parameter that can detect early subtle changes in the right ventricle in post-myocardial infarction patients. The conventional echocardiographic parameters cannot always detect subtle RV impairment. Multi-vessel disease and the need for more than one stent implantation contribute to more RV dysfunction as measured by RV strain. RV free wall strain was the strongest and most reliable predictor of RV dysfunction (RVGLS) using RVGLS multivariate analysis.
Recommendations: Use of the RV strain echocardiography to detect early subtle changes that happen early after infarction. Also, it can be used as a predictor of adverse events. To use strain as an additional parameter for a more complete RV function assessment. Increase patient awareness regarding the importance of seeking medical advice promptly if chest pain occurs to decrease the time gap from pain to presentation. Further studies based on a large-scale population are needed to confirm our study results. Further studies assessing NSTEMI in particular are much needed in this field.