Right ventricular (RV) myocardial strain (ε) is a new useful tool to evaluate RV function. The aim of our study was to use 2D speckle imaging (2DSI) on the different walls of the RV to derive regional and global indexes of RV function and to study the clinical value of these parameters in patients with first-time acute myocardial infarction (AMI).

Methods .– We analysed 30 patients admitted with AMI (58 ± 14 years, 21 inferior wall AMI and nine anterior) treated with primary percutaneous coronary intervention. We compared them to 24 healthy patients (53 ± 11 years, ns for age). Complete echocardiography was performed between two and four days after admission. To assess RV function, we analysed the three walls of the RV: septal and lateral from 4 C view and inferior from RV2 C view.

We measured maximal systolic ε (%) in the basal, median and apical segments of these three walls by 2DSI. We calculated lateral, inferior and septal ε as the means of three segments of respectively lateral, inferior and septal walls and global RV ε as the mean of these nine values. All strain values were averaged on three consecutives cycles. We also measured TAPSE, RV MPI (Tei index) and maximal velocity of systolic wave (S max) on the lateral tricuspid annulus using Doppler tissue imaging. For statistical analysis, we calculated Spearman’s correlations coefficients between RV ε values and other echographic parameters. Student t -test and Mann & Whitney test were used for group comparisons as appropriate.

Results .– All ε values correlated significantly with TAPSE, Tei index and S max (respectively, global RVε: r = −0.712 P < 0 .001; r = 0.381 P < 0 .001; r = −0.555 P < 0 .001). All ε values and TAPSE, but not Tei index or S max, were significantly higher in normal patients than in patients with AMI. Alteration of RV global ε in patients with anterior AMI was mainly due to a significant decrease in septal ε. RV global ε was more severely altered in patients with inferior than with anterior AMI, because of an additional decrease in inferior and lateral ε (see Table).

Conclusion .– 2DSI allows the calculation of RV global strain which is well correlated to standard echocardiographic parameters of RV function. Furthermore, study of regional and global RV ε adds interesting information in the evaluation of RV dysfunction in patients with AMI. A decrease of global RV ε was noted in all types of AMI and was mainly due to a decrease of septal ε in anterior AMI. In patients with inferior AMI, an additional decrease in RV inferior and lateral ε explained the lower values of RV global ε as compared to anterior AMI. Larger studies will be necessary to compare RV strain values in patients with inferior AMI extended or not to the RV.