Echocardiographic Evaluation of Hepatic Venous Doppler flow in Patients with Isolated Left Ventricle Anterior Myocardial Infarction

Abstract

Introduction: The importance of RV functions as a predictor of outcome among patients with heart failure, myocardial infarction and pulmonary embolism has been established. Hepatic venous (HV) doppler flow predicts right atrial pressure and right ventricular (RV) dysfunction. Doppler technique offers unique advantage for evaluation of RV functions in that they are independent of complex geometry and shape of RV. Aims And Objectives: To evaluate non-invasively right atrial pressure and predict right ventricular functions in patients with isolated left ventricle anterior myocardial infarction (LV-AMI) by analyzing hepatic venous doppler flow and to correlate it with left ventricle ejection fraction (LVEF) Material And Methods: The study group comprised of 50 patients with isolated LV-AMI with normal right coronary angiogram, further subdivided into 2 subgroups: Sub-group-1 consisted of 25 patients with stenosis of proximal left anterior descending artery (LAD) and Sub-group-2 composed of 25 patients with stenosis of both LAD and left circumflex artery (LCx.). The control group comprised of twenty five age, sex, BMI, pulse and blood pressure matched healthy subjects. Observations: A wave peak velocity and VTI were increased in both subgroups of AMI, X wave peak velocity and VTI was reduced in both subgroups of AMI, Y wave peak velocity and VTI was reduced in both sub-groups of AMI. VI ratio remained unchanged. On multivariate analysis LVEF and LVFS were independent negative predictors of X wave VTI. Conclusion: This study demonstrates that even in patients with isolated LV AMI there is RV dysfunction due to ‘ventricular interdependence’ and hepatic venous doppler is non - geometric sensitive echocardiographic parameter, to detect RV dysfunction non-invasively.