Author + information
- Received July 5, 1989
- Revision received October 12, 1989
- Accepted October 20, 1989
- Published online March 15, 1990.
- José López-Sendón, MD, FESC∗,
- Esteban López de Sá, MD,
- Immaculada Roldán, MD,
- Rafael Fernández de Soria, MD,
- Francisco Ramos, MD and
- Luis Martín Jadraque, MD
- ↵∗Address for reprints: José López-Sendón, MD, Coronary Care Unit, Hospital La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Inversion of the normal interatrial septum convexity has been described in patients with right atrial pressure or volume overload, but there is no reference to this abnormality in acute myocardial infarction. A group of 576 consecutive patients with acute infarction and serial echocardiographic studies were prospectively evaluated during a mean follow-up period of 406 days. Inverted interatrial septum convexity was found in 30 patients (5.2%); 29 of the 30 presented with inferior infarction with right ventricular involvement (29 [24.4%] of 119) and the remaining presented with cardiac tamponade secondary to heart rupture. The incidence of inverted interatrial septum convexity rapidly decreased, and after 3 months it was present in only five patients.
All patients with inverted interatrial septum convexity had a right atrial pressure greater or equal to pulmonary capillary pressure, a relation found in only 2 of 43 patients with right ventricular involvement and normal septal convexity. In patients with right ventricular infarction, right atrial pressure was higher in the presence of inverted septal convexity (15.9 ± 4.1 versus 10.5 ± 4.1 mm Hg, p < 0.0001) and the incidence of hypotension (10 [34.4%] of 29 versus 15 [17.4%] of 90, p = 0.04) and third degree atrioventricular block (10 [34.4%] of 29 versus 11 [12.2%] of 90, p = 0.006) as well as the mortality rate after 3 months (9 [31%] of 29 versus 11 [12.2%] of 90, p = 0.04) were higher in the presence of inverted convexity than in patients with normal convexity. Patient with right ventricular infarction treated with thrombolytic agents less frequently exhibited abnormal interatrial septum convexity than did patients without thrombolytic treatment (4 [11.1%] of 36 versus 25 [30.1%] of 83, p = 0.03).
Thus, inversion of the interatrial septum convexity 1) in patients with acute inferior infarction is related to the presence of right ventricular involvement; and 2) in patients with right ventricular infarction identifies a subgroup with a more severe degree of right ventricular dysfunction and worse prognosis. Interatrial septum convexity should be routinely evaluated in echocardiographic studies performed during acute myocardial infarction.
- Received July 5, 1989.
- Revision received October 12, 1989.
- Accepted October 20, 1989.