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Background: Patients with inferior wall ST segment elevation myocardial infarction (STEMI) are considered to be at lower risk than patients with anterior wall STEMI. Nonetheless, 30-40% of all acute inferior wall MI cases have a poor prognosis., Aim: To assess the frequency of ST segment changes (elevation or depression) in lead aVR in inferior STEMI patients, and to determine the clinical course and short-term prognosis of such patients., Methods: The study retrospectively analysed the records of 320 consecutive patients with inferior wall STEMI (206 males, 114 females, mean age 65.6 ± 11.1 years). Patients were divided into three groups based on treatment: group A, primary percutaneous coronary intervention (134 patients); group B, fibrinolytic therapy (96 patients); and group C, conservative treatment (no reperfusion therapy) (90 patients). The mean time from onset of pain to the first ECG for all patients was 6.1 h. The total number of in-hospital deaths was 29 (9.0%), comprising 11 (8.2%) in group A, seven (7.3%) in group B, and 11 (12.2%) in group C (NS). The mean maximum creatine phosphokinase was 2,021 ± 1,837 U/L in group A, 1,734 ± 1,581 U/L in group B, and 1,217 ± 981 U/L in group C (p = 0.01). The mean left ventricular ejection fraction was 50.2% ± 9.0%, 54.9 ± 8.6%, and 51.3% ± 9.7% for groups A, B and C, respectively (NS)., Results: ST segment changes in lead aVR were observed in 135 (42.2%) patients, comprising elevation in 47 (14.7%) patients and depression in 88 (27.5%) patients. The in-hospital mortality rates for patients with ST segment elevation, ST segment depression, and no ST segment changes were 27.7%, 16.5%, and 1.0%, respectively (p 〈 0.001). For group A, the in-hospital mortality rate was higher in patients with ST segment elevation than in patients with no ST segment changes (15.4% vs 1.2%, p 〈 0.001). For group B, the in-hospital mortality rates were 33.3%, 12.9%, and 0%, in patients with ST segment elevation, ST segment depression, and no ST changes, respectively (p = 0.006). For group C, the in-hospital mortality rate was higher in patients with ST segment elevation (32%) than in patients with ST segment depression (12.5%) and patients with no ST segment changes (2%, p = 0.006). Logistic regression analysis found that female gender, diabetes, hypertension, lower ejection fraction, and cardiogenic shock on admission were independent predictors of ST segment elevation., Conclusions: ST segment changes in lead aVR occurred in approximately half of inferior wall STEMI patients. The presence of such ST segment changes was associated with a poorer prognosis during the hospital stay, and the changes were not associated with the type of reperfusion treatment.

Background: Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI) treated by primary percutaneous coronary intervention (pPCI)., Aim: To evaluate the diagnostic and prognostic significance of RV myocardial velocities compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients., Methods: Consecutive patients with first, acute, inferior STEMI treated with pPCI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed after pPCI within 24 h of the onset of symptoms. Follow up including in-hospital events was performed., Results: Out of 101 patients (58 males, mean age 63.7 ± 11.1 years), RVMI was found in 37 (37%). In multivariate analysis, peak systolic RV velocity (SmRV) (OR 5.12), peak early diastolic RV velocity (EmRV) (OR 5.03) and RV wall motion abnormalities (OR 4.94) were independent parameters for RVMI diagnosis. Receiver operating characteristics revealed high diagnostic significance of SmRV (C statistics = 0.90) and EmRV (C statistics = 0.89). The SmRV < 12 cm/s as a cut-off for a diagnosis of RVMI had a 89% sensitivity and a 83% specificity, whereas EmRV < 10 cm/s - 81% and 80%, respectively. Multivariate analysis showed that two variables - SmRV and ST-segment elevation ≥ 0.1 mV in lead V4R, were independent predictors of in-hospital prognosis., Conclusions: Right ventricular myocardial velocities derived from TDI predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. Their high negative predictive value may be of practical importance when ECG tracings are equivocal. More importantly, decreased RV systolic myocardial Doppler velocity predicts unfavourable clinical outcomes in patients with inferior STEMI independently of ECG changes.