Incidence and significance of right ventricular involvement in infarction in patients with acute coronary syndrome with persistent ST-segment elevation in inferior leads of electrocardiograms

Akutni infarkt miokarda (AIM) kao najozbiljnija manifestacija koronarne srčane bolesti predstavlja vodeći uzrok smrti u razvijenim zemljama. Infarkt miokarda sa ST-elevacijom (STEMI) je u pravilu transmuralni infarkt s potpunom okluzijom koronarne arterije koji se mora hitno liječiti revaskularizacijom miokarda. AIM inferiorne stijenke lijeve klijetke prepoznaje se promjenama u tzv. inferiornim odvodima elektrokardiograma (EKG-a), a to su II. I III. standardni odvod te aVF odvod na klasičnom 12-kanalnom EKG-u. Inferiorni STEMI nije najčešći oblik STEMI, a može konkomitantno zahvatiti posteriornu i lateralnu stijenku lijeve klijetke, ali i desnu klijetku. Zahvaćanje desne klijetke infarktom pri inferiornom STEMI može biti uzrok komplikacija i lošijeg ishoda. Infarkt desne klijetke se u EKG-u vidi u tzv. desnim odvodima EKG-a (elevacijom u V3 i/ili V4) ili ehokardiografski. Cilj našeg istraživanja je bio utvrditi pojavnost zahvaćenosti desne klijetke infarktom kod bolesnika primljenih s dijagnozom inferiornog STEMI tijekom godinu dana. Također, cilj je bio i odrediti značaj zahvaćenosti desne klijetke u petogodišnjem praćenju na pojavnost reinfarkta i preživljenje. Prikupili smo podatke ukupno 111 bolesnika koji su tokom 2015. bili hospitalizirani u Kliničkom bolničkom centru Zagreb pod diijagnozom inferiornog STEMI. Od 103 bolesnika koji su otpušteni nakon hospitalizacije, njih 15 (14,6%) imalo je zahvaćenu desnu klijetku infarktom. Rezultati nisu pokazali statistički značajan utjecaj infarkta desne klijetke na pojavnost reinfarkta i preživljenje tijekom 5-godišnjeg praćenja. Veći ispitivani uzorak i dodatna istraživanja potrebna su kako bi potvrdila rezultate ove studije.Acute myocardial infarction (AMI) is the most severe manifestation of coronary heart disease and the leading cause of death in developed countries. ST-elevation myocardial infarction (STEMI) is a transmural infarction with complete coronary artery occlusion that must be treated urgently with revascularization. AMI of the inferior left ventricular wall is recognized by changes in II, III and aVF leads of the electrocardiogram (ECG). Inferior STEMI is not the most common form of STEMI. It can concomitantly affect posterior and lateral left ventricular wall, and right ventricle. Right ventricular involvement in inferior STEMI can be a cause of complications and worse outcomes. Right ventricular infarction is detected with right ECG leads (ST elevation in V3 and/or V4) or with echocardiography. The aim of our study was to determine the incidence and significance of right ventricular involvement in patients with inferior STEMI. We observed the impact of right ventricular infarction on one- and five-year survival rate and on the incidence of reinfarction in patients with previous inferior STEMI. In total, we collected data on 111 patients which were hospitalized in University Hospital Centre Zagreb throught 2015 with the diagnosis of inferior STEMI. Out of 103 discharged patients, 15 (14.6%) had right ventricle infarction. The results did not show a significant effect of right ventricular involvement on reinfarction rate and 5-year survival. Further studies with larger number of enrolled patients are needed to confirm the results of this study