Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction
Introduction: Right Ventricular Myocardial Infarction (RVMI) along with inferior wall left ventricular (LV) dysfunction or Inferior Wall Myocardial Infarction (IWMI) is found in 30-50% of the cases. Isolated Right Ventricular (RV) dysfunction or infarction is rare except in iatrogenic (intervent...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2020-11-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/14321/47081_CE[Ra1]_F(SL)_PF1_(SS_OM)_PFA_(OM)_PN(SL).pdf |
| _version_ | 1818363741298753536 |
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| author | Rajeev Bharadwaj Ranjit Kumar Nath Ashok Thakur Bhagya Narayan Pandit Dheerendra Kuber |
| author_facet | Rajeev Bharadwaj Ranjit Kumar Nath Ashok Thakur Bhagya Narayan Pandit Dheerendra Kuber |
| author_sort | Rajeev Bharadwaj |
| collection | DOAJ |
| description | Introduction: Right Ventricular Myocardial Infarction (RVMI)
along with inferior wall left ventricular (LV) dysfunction or Inferior
Wall Myocardial Infarction (IWMI) is found in 30-50% of the
cases. Isolated Right Ventricular (RV) dysfunction or infarction
is rare except in iatrogenic (interventional) procedures. RVMI is
being more commonly diagnosed retrospectively in the era of
primary angioplasty, when these patients post-procedure fail to
improve satisfactorily as compared to isolated IWMI patients.
Clues to identify early RV involvement in acute IWMI patients
will help in better management and less morbidity in this group
of patients.
Aim: The study was undertaken to search for any correlation
between cardiac biomarkers {Troponin I (Trop I), Creatinine
Kinase-MB (CK-MB), Brain Natriuretic Peptide (BNP)} and RV
involvement using echocardiographic parameters in inferior
Acute Myocardial Infarction (AMI), with and without associated
RVMI, in patients who underwent primary Percutaneous Coronary
Intervention (PCI).
Materials and Methods: This was a cross-sectional study,
conducted from September, 2018 to August, 2019, in the
Cardiology Department of ABVIMS and Dr. Ram Manohar Hospital.
A total of 294 patients, presenting with acute IWMI, were included
in the study. Samples for Trop-I, CK-MB and BNP were taken
immediately after admission. One hundred and thirty two patients
had an associated RVMI. Two-dimensional Echocardiography was
done within the first 12 hours of admission. Electrocardiography
(ECG) and Echocardiography (EEG) assessments were used
to determine RV involvement. Comparison was done first
between patients with and without RV involvement, followed by
comparison among groups for quantitative parameters, especially
biomarkers, for finding correlation between biomarker levels and
echocardiographic parameters (both RV and LV functions).
Results: Patients presenting with IWMI with an associated
RVMI had increased LV E/E’ ratio. Also, as predicted, they had
a low Tricuspid Annulus Plane Systolic Excursion (TAPSE) and a
low RV fractional area change, as well, due to stunning of right
ventricle in the acute phase. In the group with higher BNP levels
(≥400 pg/mL), the ratio of transmitral Doppler early filling velocity
to tissue Doppler early diastolic mitral annular velocity (E/E’) was
increased; on the other hand LV ejection fraction and TAPSE
were decreased. There was negative correlation between RSm
(RV systolic wave), TAPSE and BNP levels. BNP, Trop I and CKMB levels showed a positive correlation with E/E’ at higher levels.
Hypotension was more in patients presenting with RVMI, but it
did not reach statistical significance. The mortality was 4.5% in
the inferior Myocardial Infarction (MI) with RV involvement group
versus 1.8% in isolated inferior MI group (during hospital stay).
Conclusion: In acute Inferior wall MI, higher levels of BNP, CKMB, Trop I, alone or in combination, might be used for prediction
of RV involvement. BNP levels ≥400 pg/mL, Trop I levels ≥1.1 ng/
mL, and CK-MB levels ≥4.5 ng/mL, along with hypotension
and higher E/E’ ratio were observed in such cases and were
associated with RV dysfunction and increased mortality. |
| first_indexed | 2024-12-13T21:53:17Z |
| format | Article |
| id | doaj.art-848ecac9119643458487dc5ac005fc04 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-12-13T21:53:17Z |
| publishDate | 2020-11-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-848ecac9119643458487dc5ac005fc042022-12-21T23:30:13ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2020-11-011411OC34OC3710.7860/JCDR/2020/47081.14321Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial InfarctionRajeev Bharadwaj0Ranjit Kumar Nath1Ashok Thakur2Bhagya Narayan Pandit3Dheerendra Kuber4Senior Resident, Department of Cardiology, ABVIMS and Dr. RML Hospital, Delhi, India.Professor and Head, Department of Cardiology, ABVIMS and Dr. RML Hospital, Delhi, India.Senior Resident, Department of Cardiology, ABVIMS and Dr. RML Hospital, Delhi, India.Associate Professor, Department of Cardiology, ABVIMS and Dr. RML Hospital, Delhi, India.Assistant Professor, Department of Cardiology, ABVIMS and Dr. RML Hospital, Delhi, India.Introduction: Right Ventricular Myocardial Infarction (RVMI) along with inferior wall left ventricular (LV) dysfunction or Inferior Wall Myocardial Infarction (IWMI) is found in 30-50% of the cases. Isolated Right Ventricular (RV) dysfunction or infarction is rare except in iatrogenic (interventional) procedures. RVMI is being more commonly diagnosed retrospectively in the era of primary angioplasty, when these patients post-procedure fail to improve satisfactorily as compared to isolated IWMI patients. Clues to identify early RV involvement in acute IWMI patients will help in better management and less morbidity in this group of patients. Aim: The study was undertaken to search for any correlation between cardiac biomarkers {Troponin I (Trop I), Creatinine Kinase-MB (CK-MB), Brain Natriuretic Peptide (BNP)} and RV involvement using echocardiographic parameters in inferior Acute Myocardial Infarction (AMI), with and without associated RVMI, in patients who underwent primary Percutaneous Coronary Intervention (PCI). Materials and Methods: This was a cross-sectional study, conducted from September, 2018 to August, 2019, in the Cardiology Department of ABVIMS and Dr. Ram Manohar Hospital. A total of 294 patients, presenting with acute IWMI, were included in the study. Samples for Trop-I, CK-MB and BNP were taken immediately after admission. One hundred and thirty two patients had an associated RVMI. Two-dimensional Echocardiography was done within the first 12 hours of admission. Electrocardiography (ECG) and Echocardiography (EEG) assessments were used to determine RV involvement. Comparison was done first between patients with and without RV involvement, followed by comparison among groups for quantitative parameters, especially biomarkers, for finding correlation between biomarker levels and echocardiographic parameters (both RV and LV functions). Results: Patients presenting with IWMI with an associated RVMI had increased LV E/E’ ratio. Also, as predicted, they had a low Tricuspid Annulus Plane Systolic Excursion (TAPSE) and a low RV fractional area change, as well, due to stunning of right ventricle in the acute phase. In the group with higher BNP levels (≥400 pg/mL), the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/E’) was increased; on the other hand LV ejection fraction and TAPSE were decreased. There was negative correlation between RSm (RV systolic wave), TAPSE and BNP levels. BNP, Trop I and CKMB levels showed a positive correlation with E/E’ at higher levels. Hypotension was more in patients presenting with RVMI, but it did not reach statistical significance. The mortality was 4.5% in the inferior Myocardial Infarction (MI) with RV involvement group versus 1.8% in isolated inferior MI group (during hospital stay). Conclusion: In acute Inferior wall MI, higher levels of BNP, CKMB, Trop I, alone or in combination, might be used for prediction of RV involvement. BNP levels ≥400 pg/mL, Trop I levels ≥1.1 ng/ mL, and CK-MB levels ≥4.5 ng/mL, along with hypotension and higher E/E’ ratio were observed in such cases and were associated with RV dysfunction and increased mortality.https://jcdr.net/articles/PDF/14321/47081_CE[Ra1]_F(SL)_PF1_(SS_OM)_PFA_(OM)_PN(SL).pdfbrain natriuretic peptidedoppler echocardiographyright ventricular involvementtricuspid annular plane systolic excursiontroponin i |
| spellingShingle | Rajeev Bharadwaj Ranjit Kumar Nath Ashok Thakur Bhagya Narayan Pandit Dheerendra Kuber Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction Journal of Clinical and Diagnostic Research brain natriuretic peptide doppler echocardiography right ventricular involvement tricuspid annular plane systolic excursion troponin i |
| title | Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction |
| title_full | Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction |
| title_fullStr | Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction |
| title_full_unstemmed | Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction |
| title_short | Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction |
| title_sort | correlation between cardiac biomarkers and right ventricular dysfunction in acute inferior wall myocardial infarction with and without right ventricular myocardial infarction |
| topic | brain natriuretic peptide doppler echocardiography right ventricular involvement tricuspid annular plane systolic excursion troponin i |
| url | https://jcdr.net/articles/PDF/14321/47081_CE[Ra1]_F(SL)_PF1_(SS_OM)_PFA_(OM)_PN(SL).pdf |
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