Cardiovascular Journal of Africa: Vol 27 No 1 (January/February 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016

AFRICA

The change in right ventricular systolic function

according to the revascularisation method used,

following acute ST-segment elevation myocardial

infarction

Ilker Gul, Mustafa Zungur, Ahmet Cagri Aykan, Tayyar Gokdeniz, Mustafa Beyazit Alkan, Ahmet Sayin,

Aysel Islamli, Murat Bilgin, Ezgi Kalaycio

lu, Turhan Turan

Abstract

Objective:

The level of right ventricular (RV) systolic function

has prognostic importance in right ventricular ST-segment

elevation myocardial infarction (RV-STEMI). This study

aimed to evaluate the changes in RV systolic function in

patients with RV-STEMI according to the revascularisation

method used for their management.

Methods:

The first group consisted of 132 patients who

received primary percutaneous coronary intervention (PPCI).

The 78 patients who had received thrombolytic therapy (TT)

in external centres before referral to our centre for PCI within

three to 12 hours of RV-STEMI were included in the second

group. All patients were evaluated by conventional and two-

dimensional speckle-tracking echocardiography.

Results:

There were 172 male patients and their mean age

was 63.7

11.8 years. There were no significant differ-

ences between the two groups with regard to right ventricu-

lar systolic parameters at admission and at the one-month

follow-up visit. The echocardiographic changes between

admission and the one-month follow up were investigated

for the patients included in the study groups. Mean values of

each parameter observed at the one-month follow up were

significantly increased compared to those at admission within

each group.

Conclusion:

Our study demonstrated that PCI within three

to 12 hours following TT provided similar benefits on right

ventricular systolic function compared to PPCI in patients

with RV-STEMI.

Keywords:

ST-elevation myocardial infarction (STEMI), primary

percutaneous coronary intervention (PPCI), thrombolytic thera-

py (TT), right ventricular systolic function

Submitted 19/5/15, accepted 3/10/15

Cardiovasc J Afr

2016;

: 37–44

www.cvja.co.za

DOI: 10.5830/CVJA-2015-077

ST-elevation myocardial infarction (STEMI) is characterised by

a loss of contractile tissue and a change in ventricle geometry

that causes substantial impairment of the ventricular systolic

and diastolic functions.

In coronary artery disease (CAD), left

ventricular (LV) function has been widely evaluated by means of

echocardiographic methods. LV function has long been known

to be among the most important determinants of morbidity

and mortality.

2,3

However, the right ventricle (RV) has been the

subject of fewer studies compared to the left ventricle.

RV-STEMI has been reported in 10 to 60% of patients with

inferior STEMI.

4-6

The co-existence of inferior STEMI and

RV-STEMI has been shown to increase morbidity and mortality

rates.

7,8

The time lapse between the onset of symptoms and admission

to hospital is known as the symptom-to-door time. Myocardial

damage and cardiac complications are more likely to progress

with prolonged periods without intervention after STEMI.

9,10

Current guidelines emphasise the benefits of reperfusion within

the first 12 hours after STEMI.

Successful reperfusion within the first three hours is reported

to provide improved prognosis. For this purpose, the selection

of appropriate reperfusion strategy is an important discussion

topic. Reperfusion strategies include fibrinolysis and primary

percutaneous coronary intervention (PPCI) techniques. PPCI is

preferable in a 24-hours-a-day, seven-days-a-week centre with an

established coronary intervention facility.

When the transfer time from centres without coronary

intervention laboratories does not exceed 120 minutes and the

door-to-balloon time does not exceed 90 minutes, PPCI is again

Department of Cardiology, Faculty of Medicine,

ifa

University, Izmir, Turkey

Ilker Gul, MD,

drilkergul46@gmail.com

Mustafa Zungur, MD

Aysel Islamli, MD

Department of Cardiology, Ahi Evren Thoracic and

Cardiovascular Surgery Training and Research Hospital,

Trabzon, Turkey

Ahmet Cagri Aykan, MD

Ezgi Kalaycio

lu, MD

Turhan Turan, MD

Department of Cardiology, Faculty of Medicine, Kafkas

University, Kars, Turkey

Tayyar Gokdeniz, MD

Department of Cardiology, Acıpayam State Hospital,

Denizli, Turkey

Mustafa Beyazit Alkan, MD

Department of Cardiology, Tepecik Education and

Research Hospital, Izmir, Turkey

Ahmet Sayin, MD

Department of Cardiology, Dı

kapı Yıldırım Beyazıt Training

and Research Hospital, Ankara, Turkey

Murat Bilgin, MD