The state of systolic function and diastolic filling of the myocardium in patients with right ventricular myocardial infarction on the background of the Q-wave myocardial infarction of the left ventricle during 6 months of follow-up
Background. Remodeling after right ventricular myocardial infarction (RV MI) is associated with a poor prognosis. The aim of the study is to evaluate the dynamics of the postinfarction remodeling and the diastolic dysfunction of the left (LV) and right ventricle in patients with RV MI on the background of the Q-MI of the LV and their relationship with the heart failure progression within 6 months of follow-up. Materials and methods. 309 patients with the Q-MI aged 65.50 ± 4.42 years were examined. 155 patients with RV MI on the background the Q-MI of LV posterior wall were included into the 1st group; 2nd group consisted of 53 patients with the RV MI due the Q-MI of the LV of circular localization, and the control group — of 101 patients with the Q-MI of the LV posterior wall. Doppler echocardiography was performed on day 4–5 of acute MI and 6 months after the MI. Results. In patients with RV MI in the acute period, pseudonormal and restrictive type of diastolic dysfunction of the LV and RV (p < 0.05) prevailed, which were formed on the background of significant dilatation of the left and right atrium of the LV and RV (p < 0.05), lower contractility of the LV and RV and increased systolic pressure in the pulmonary artery (p < 0.05) that was associated with a high incidence of fatal arrhythmias (p < 0.05) and severe manifestations of acute heart failure, in particular, the Killip III and cardiogenic shock, as compared with the control group (p < 0.05). The positive dynamics of systolic and diastolic function of the LV and RV was observed after 6 months; in particular, there were cases of diastolic function normalization and prevalence of the relaxation type of the diastolic dysfunction (p < 0.05). Despite this, in patients suffered from RV MI, the progression of heart failure was detected: the IIA stage and the New York Heart Association class III (p < 0.05) were diagnosed more often compared with the control group. Conclusions. The RV MI on the background of the Q-MI of the LV were accompanied by more severe disturbances of the systolic and diastolic function of the LV and RV and associated with a high incidence of fatal arrhythmias, pulmonary edema and cardiogenic shock in the acute period, as well as with the progression of heart failure within 6 months of follow-up.
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