The significance of right ventricular (RV) function was first highlighted in 1616 by Sir William Harvey in his seminal work De Motu Cordis, where he emphasized the RV’s role in circulating blood through the lungs rather than nourishing the body directly. Decades later, from the 1950s through the 1970s, cardiac surgeons began to recognize the importance of preserving RV function, particularly during surgeries involving the right heart, as they observed its critical contribution to overall cardiac performance. [1] Today, RV function is well established as a major determinant in various cardiac pathologies, including heart failure, myocardial infarction, congenital heart disease, and pulmonary hypertension. Approximately 40% of all acute myocardial infarctions involve the inferior wall of the left ventricle, a region often associated with a comparatively lower baseline mortality. However, when RV involvement occurs in these cases, the risk of complications and mortality increases significantly. This is largely due to the added burden of RV dysfunction, which contributes to poor hemodynamics and worsened outcomes. Patients with RV involvement in inferior wall myocardial infarction (IWMI) are at a heightened risk of in-hospital mortality and major cardiovascular complications, in contrast to those with isolated IWMI. RV infarction is now understood to be an independent predictor of increased mortality and prolonged hospital stays. Moreover, ischemia affecting the conduction pathways in RV infarction often results in atrioventricular block, necessitating temporary or permanent pacing. Studies have shown that patients with RV infarction may require long-term pacing devices due to persistent conduction disturbances. [2] Additionally, acute RV infarction is reported in nearly 50% of patients with inferior wall MI, especially when the right coronary artery—which supplies both the RV and part of the interventricular septum—is occluded. This leads to RV systolic dysfunction and chamber dilatation. Clinical deterioration is more common when RV infarction is accompanied by significant hemodynamic compromise, occurring in up to 25–50% of such patients. Early mortality is particularly high in those with RV involvement, largely due to hypotension, shock, and arrhythmias. [3] For instance, mortality among inferior MI patients with RV infarction ranges between 25–30%, in contrast to around 6% in those without RV involvement. Although inferior MIs generally carry a better prognosis compared to anterior MIs, the presence of RV infarction significantly alters this outcome. Given the burden of cardiovascular disease as a leading cause of death globally, and considering that ischemic heart disease contributes to approximately 32% of global mortality, this study aims to evaluate the clinical impact of RV wall motion abnormality in patients with acute inferior wall MI, particularly its correlation with complications and short-term in-hospital outcomes

Study Design: Cross sectional Descriptive type of study.

Study Setting: This study was conducted in-patients under the department of   medicine, Agartala Government Medical College and GB Pant Hospital.

Study Period: This study was completed within one Year, One Year for data collection and data management (JUNE 2024- MAY 2025).

Study Population: All diagnosed patients of acute myocardial infarction admitted in medicine ward of AGMC & GBP Hospital. Out of all cases of myocardial infarction, inferior wall myocardial infarction was my study population.

Sample Size: 110 patients with acute inferior wall myocardial infarction.

Inclusion Criteria

• Patients admitted with acute Inferior wall Myocardial Infarction.

Exclusion Criteria:

• Pregnancy with Inferior wall MI.
• Patients who had not given written informed consent for the study.

Study Parameter:

• Age and sex of patients
• Extent of Inferior Wall Myocardial Infarction
• TAPSE
• RV Myocardial performance index

Table no 1: Distribution of Co morbid Condition of Study Population.

Table no 2: Association between Echocardiographic RV dysfunction : Outcome

Table no 3: Association between RV dysfunction : Duration Of Hospital Stay

Figure 1: Distribution of Co Morbid condition.

Figure 2: Association between RV dysfunction on echocardiography: Outcome

Figure 3: Association between RV dysfunction: Duration of Hospital Stay

In our study, hypertension was the most common comorbid condition, observed in 54 patients (49.1%), followed by diabetes in 23 patients (20.9%). Dyslipidaemia was present in 8 patients (7.3%), and a family history of cardiovascular diseases (FHO CVDs) was noted in 2 patients (1.8%). Notably, 23 patients (20.9%) had no comorbid conditions. The calculated z-value was 8.0482, with a corresponding p < .00001, indicating statistical significance at p < .05. Right ventricular (RV) dysfunction was assessed using two echocardiographic parameters: Tricuspid Annular Plane Systolic Excursion (TAPSE) and Right Ventricular Myocardial Performance Index (RVMPI). Patients were classified as having RV dysfunction only if both parameters were abnormal—defined as TAPSE < 17 mm and RVMPI > 0.55. Clinical outcomes showed marked differences between patients with and without RV dysfunction. Among those without RV dysfunction, 67.7% (n=44) had survival without complications, while 23.1% (n=15) developed arrhythmias. Only 3.1% (n=2 each) experienced death, heart failure, or hypotension/shock. In contrast, patients with RV dysfunction demonstrated significantly worse outcomes: 55.6% (n=25) developed hypotension or cardiogenic shock, 17.8% (n=8) experienced death, 13.3% (n=6) developed heart failure, and just 8.9% (n=4) achieved survival without complications. This difference in clinical outcomes between the two groups was highly significant (p < 0.0001). Hospital stay duration also varied notably between the groups. In patients without RV dysfunction, 80.0% (n=52) were discharged within 1 to 5 days, and 20.0% (n=13) stayed for 6 to 10 days, with no patient requiring hospitalization beyond 10 days. Conversely, patients with RV dysfunction had significantly prolonged hospital stays: only 28.9% (n=13) were discharged within 1 to 5 days, 48.9% (n=22) remained hospitalized for 6 to 10 days, and 22.2% (n=10) required stays of 11 to 15 days. This difference in hospitalization duration between the two groups was statistically significant (p = 0.0001).

In similar study by Pradhan et al. [4] (2018) found that, where 47% of IWMI patients had hypertension, without significant correlation to RV involvement .We found that, a significantly higher number of patients—54 (49.1%)—had hypertension, it the most common comorbid condition it was statistically significant (p < 0.00001).

In a similar study by Srinivasan SS et al [5] (2023) on 200 Inferior wall MI patients with or without RV involvement found that complications such as atrial fibrillation (39%) cardiogenic shock (30%), AV blocks (25%), ICCU stays> 7 days, death (10%) significantly more in patients with RVMI ( P value< 0.001).In our study, a higher number of patients without RV dysfunction had a favorable outcome, with 44 patients (67.7%) achieving survival without complications. In contrast, only 4 patients (8.9%) with RV dysfunction showed a similar outcome. This difference was highly significant (p < 0.0001).

In Similar study by Yamin et al., who found that patients with right ventricular dysfunction had significantly longer hospital stays (median 7.0 vs. 5.0 days, p < 0.001) and higher in-hospital mortality rates compared to those without dysfunction, supporting our observation that RV involvement adversely impacts clinical outcomes. In our study, a higher number of patients without RV wall motion abnormality had shorter hospital stays, with 52 patients (80.0%) discharged within 1 to 5 days. In contrast, only 13 patients (28.9%) with RV wall motion abnormality had similar short stays. This difference was statistically significant (p = 6.25).

We concluded that the research demonstrates the substantial influence that cardiac dysfunction and concomitant diseases have on patient outcomes. The most common comorbidity was found to be hypertension, which affected 54 patients and was statistically significant. Only 4 patients with right ventricular (RV) dysfunction achieved complication-free survival, compared to 44 patients without RV dysfunction. This indicates a substantial correlation between RV dysfunction and worse outcomes. A longer hospital stay was also associated with RV wall motion abnormalities; just 13 patients with the anomaly were discharged within 1–5 days, compared to 52 patients without it. These results highlight how crucial early identification and treatment of hypertension and RV dysfunction are for enhancing clinical outcomes.

1. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008 Mar 18;117(11):1436-48.
2. Martin H, Izquierdo W, Cabrerizo M, Cabrera A, Adjouadi M. Near real-time single-beat myocardial infarction detection from single-lead electrocardiogram using Long Short-Term Memory Neural Network. Biomedical Signal Processing and Control. 2021 Jul 1;68:102683.
3. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN. Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation. 2018 May 15;137(20):e578-622.
4. Pradhan R, Jain A, Goel PK. Role of echocardiography in right ventricular myocardial infarction. Indian Heart J. 2018;70(Suppl 3):S223–7.
5. Shujaat A, Kazmi S, Arshad M, et al. Correlation of right ventricular infarction with outcomes in inferior wall myocardial infarction. J Coll Physicians Surg Pak. 2015;25(11):808–13.
6. Srinivasan SS, Arun R, Rudrappa A, Kumar RS. Clinical profile, Prognosis and Outcome in patients with Right Ventricular Myocardial Infarction(RVMI) and without RVMI IN Inferior Wall Myocardial Infarction (IWMI). Int J Acad Med Pharm. 2023;5(3):150-3.
7. Mehta SR, Eikelboom JW, Natarajan MK, et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol. 2001;37(1):37–43