ANNULAR MPI RATIO OF TISSUE DOPPLER IMAING (.pptx

Inferior wall myocardial infarction in association with right ventricular involvement occurs in 30-50% of patients and is caused mainly by Right Coronary artery involvement.

Tissue Doppler imaging is a technique which measures myocardial velocities quantitatively in both phases of cardiac cycle.
The culprit artery involved in Acute inferior wall myocardial infarcts is mostly the right coronary artery and next is left circumflex artery and very rarely due to wrap around LAD

In the era of coronary intervention knowing of infarct related artery by tissue Doppler imaging prior to coronary intervention is useful to select the hardwares needed for RCA or LCx artery PCI.
To test the usefulness of Ratio of Lateral mitral annular myocardial performance index & lateral Tricuspid annular myocardial performance index using TDI in identification of culprit vessel whether it is right coronary artery or left circumflex.
The study will be conducted at LPSIC in the department of cardiology.
Hospital based cross sectional study
Study subjects : 100 patients with acute IWMI presenting first time with acute onset of chest pain within previous 24 hours
Echo cardiography :Two dimensional color Doppler and pulse wave Doppler will be performed 24 hours from the time of admission.Patients with IWMI may also experience right ventricular infarction (RVI) or lateral and posterior wall infarction, both of which are linked to specific hemodynamic disturbances and increased mortality rates. In addition to left ventricular ejection fraction (LVEF), which predicts outcomes in left ventricular infarcts, the areas supplied by the RCA to the right ventricle also modify the prognosis. Atrioventricular (AV) blocks are frequently observed in IWMI, and right ventricular infarction occurs in 10-50% of IWMI cases, predicting higher rates of in-hospital mortality and morbidity. Nearly half of these patients develop AV blocks, compared to only 13% of those without right ventricular involvement. While left ventricular systolic function may be preserved, reduced right ventricular filling in RVMI leads to decreased left ventricular preload. Both the decreased preload and conduction blocks contribute to increased complications.
Patients with RVMI face a 31% mortality rate, compared to 6% in those without right ventricular involvement. RVMI is associated with higher rates of shock and arrhythmias. Even in the era of percutaneous coronary intervention (PCI), RV involvement results in a 15% increase in major adverse cardiovascular events (MACE) compared to 8% in cases of IWMI or anterior wall MI. Although right ventricular infarction associated with IWMI was first recognized two decades ago, its significance has only recently been emphasized. RV involvement at the time of presentation with IWMI is linked to a 7.7-fold increased risk of in-hospital mortality (95% CI, 2.6-23) and a 4.7-fold increased risk of major in-hospital complications (95% CI, 2.4-9.95).

1. A STUDY ON CORRELATION OF ANNULAR MPI RATIO USING TISSUE DOPPLER IMAING (TDI) IN ACUTE INFERIOR WALL MYOCARDIAL INFARCTION WITH CORONARY ANGIOGRAM FOR IDENTIFYING CULPRIT VESSEL Dr imran kamal khan

2. INTRODUCTION Inferior wall myocardial infarction in association with right ventricular involvement occurs in 30-50% of patients and is caused mainly by Right Coronary artery involvement. Tissue Doppler imaging is a technique which measures myocardial velocities quantitatively in both phases of cardiac cycle.

3. The culprit artery involved in Acute inferior wall myocardial infarcts is mostly the right coronary artery and next is left circumflex artery and very rarely due to wrap around LAD In the era of coronary intervention knowing of infarct related artery by tissue Doppler imaging prior to coronary intervention is useful to select the hardwares needed for RCA or LCx artery PCI.

4. AIMS AND OBJECTIVES To test the usefulness of Ratio of Lateral mitral annular myocardial performance index & lateral Tricuspid annular myocardial performance index using TDI in identification of culprit vessel whether it is right coronary artery or left circumflex .

5. METHODOLOGY The study will be conducted at LPSIC in the department of cardiology. Hospital based cross sectional study Study subjects : 100 patients with acute IWMI presenting first time with acute onset of chest pain within previous 24 hours Echo cardiography : Two dimensional color Doppler and pulse wave Doppler will be performed 24 hours from the time of admission.

6. Myocardial performance of Tricuspid annulus will be calculated as IVRT + IVCT / ET by the values obtained from RV free wall at the level of the lateral tricuspid annulus Myocardial performance index of Mitral annulus will be calculated in a similar way like previously but by placing the sample volume at LV free wall at the level of lateral mitral annulus. Coronary angiography : will be performed in mean window period of 12-36 hours. Total or > 70% occlusion of coronary artery supplying the asymmetric field was accepted as infarct related artery defining feature.

7. Exclusion criterias : 1) Concomitant involvement of kidney Disease and elevated serum creatinine >1.7 mg% 2) Those who have documented h/o previous MI 3 ) Those who are not willing for Coronary angiography 4) Associated Comorbid conditions like pericardial diseases , COPD ,PHT Moderate to sever valvular heart disease ,AF , LBBB ,Congenital Heart disease, RV and LV cardiomyopathy