Echocardiography | 2019
Reply to the Letter to the Editor: Evaluation of right atrial volumes and functions by real time three‐dimensional echocardiography in patients after acute inferior myocardial infarction
Abstract
We would like to thank Dr. Davarpasand for his interest in our article entitled “Evaluation of right atrial volumes and functions by real time threedimensional echocardiography in patients after acute inferior myocardial infarction” and for taking time to write his opinions. In his letter to the editor, Dr. Davarpashand noted the potential effect of right atrial branches perfusion state and right atrial ischemia/infarction on right atrial phasic volumes and mechanical functions in patients with right ventricular myocardial infarction, pointed out the need of a study that clarifies the perfusion state of right atrium in the presence of inferior wall and right ventricular myocardial infarction, and compared the right atrial function in impaired and unimpaired right atrial perfusion. There are several arteries supplying blood to the right atrium, mostly the earliest branches of the right coronary artery (RCA) after the conus artery originating along the right atrioventricular groove. Therefore, atrial ischemia and infarction are not uncommon in patients with right ventricular infarction with substantial hemodynamic deterioration and proximal occlusion of the RCA.1 Atrial ischemia/ infarction may affect atrial functions and result in arrhythmias and lethal complications such as thromboembolism and atrial rupture. In our study, we defined patients with right ventricular myocardial infarction (RVMI) as those having a culprit lesion at the proximal portion of the first right ventricular marginal branch. Some of these patients might have atrial ischemia to a certain degree; however, none of the RVMI patients had ECG criteria consistent with atrial infarction.2 Besides, it is not easy to evaluate right atrial perfusion with coronary angiography of RCA since there are also several anastomoses between atrial coronary arterial systems.3 Therefore, it is not easy to compare patients according to their right atrial perfusion state. In our study, we compared patients according to the presence of RVMI. We might assume that there was no right atrial ischemia in patients without RVMI, and there might be clinically insignificant amount of atrial ischemia in patients with RVMI since none of these patients had specific ECG criteria compatible with atrial infarction and none of them developed atrial fibrillation or any other arrhythmia. Therefore, we concluded that changes in atrial phasic volumes and function resulted from changes in right ventricular systolic and diastolic functions and compliance.