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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
AFRICA
37
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
ğ
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;
27
: 37–44
www.cvja.co.zaDOI: 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.
1
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,
Ş
ifa
University, Izmir, Turkey
Ilker Gul, MD,
drilkergul46@gmail.comMustafa 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
ğ
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
ş
kapı Yıldırım Beyazıt Training
and Research Hospital, Ankara, Turkey
Murat Bilgin, MD