Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction
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Prognostic implication of right ventricular dysfunction and infarction scar in the chronic phase of the myocardial infarction has been little analyzed. In 299 consecutive patients (age 63 ± 11 years) with >3 months old myocardial infarction, we quantified right and left ventricular volumes and ejection fractions by cine cardiac magnetic resonance, and right and left ventricular scar tissue by late gadolinium enhancement. During follow-up (median, 2.4 years) cardiac events (cardiac-related deaths or appropriate intra-cardiac defibrillator shocks) occurred in 21 patients. Right ventricular systolic dysfunction (ejection fraction lower the reference mean values—2 SD) was present in 67 patients (22 %), right ventricular late gadolinium enhancement was observed in 15 patients (5 %). After adjustment for left ventricular end-diastolic volume, wall motion score index, and global extent of late gadolinium enhancement, right ventricular dysfunction was an independent and incremental predictor of cardiac events (p = 0.0053), while right ventricular scar tissue extent was not. Right ventricular dysfunction is an independent and incremental predictor of cardiac events also in the chronic phase of the myocardial infarction. In these patients, right ventricular dysfunction does not necessarily mean right ventricular infarction scar, but likely reflects the effects of hemodynamic and biohumoral factors.
KeywordsRight ventricular function Myocardial scar tissue Cardiac magnetic resonance Previous myocardial infarction
We are grateful to Claudia Santarlasci for her administrative support.
Conflict of Interest
- 3.Foussas SG, Zairis MN, Tsiaousis GZ, Theodossis-Georgilas A, Prekates AA, Kontos CF et al (2010) The impact of right ventricular involvement on the postdischarge long-term mortality in patients with acute inferior ST-segment elevation myocardial infarction. Angiology 61:179–183CrossRefPubMedGoogle Scholar
- 4.Shah PK, Maddahi J, Staniloff HM, Ellrodt AG, Pichler M, Swan HJ, Berman DS et al (1986) Variable spectrum and prognostic implications of left and right ventricular ejection fractions in patients with and without clinical heart failure after acute myocardial infarction. Am J Cardiol 58:387–393CrossRefPubMedGoogle Scholar
- 9.Miszalski-Jamka T, Klimeczek P, Tomala M, Krupiński M, Zawadowski G, Noelting J et al (2010) Extent of RV dysfunction and myocardial infarction assessed by CMR are independent outcome predictors early after STEMI treated with primary angioplasty. JACC Cardiovasc Imaging 3:1237–1246CrossRefPubMedGoogle Scholar
- 10.Grothoff M, Elpert C, Hoffmann J, Zachrau J, Lehmkuhl L, de Waha S et al (2012) Right ventricular injury in ST-elevation myocardial infarction: risk stratification by visualization of wall motion, edema, and delayed-enhancement cardiac magnetic resonance. Circ Cardiovasc Imaging 5:60–68CrossRefPubMedGoogle Scholar
- 13.Berger PB, Ruocco NA Jr, Ryan TJ, Jacobs AK, Zaret BL, Wackers FJ et al (1993) Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the thrombolysis in myocardial infarction [TIMI] II trial). The TIMI Research Group. Am J Cardiol 71:1148–1152CrossRefPubMedGoogle Scholar
- 15.Di Bella G, Siciliano V, Aquaro GD, Molinaro S, Lombardi M, Carerj S et al (2013) Scar extent, left ventricular end-diastolic volume, and wall motion abnormalities identify high-risk patients with previous myocardial infarction: a multiparametric approach for prognostic stratification. Eur Heart J 34:104–111CrossRefPubMedGoogle Scholar
- 16.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542CrossRefPubMedGoogle Scholar
- 18.Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM et al (2014) ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Cardiol Fail 20:65–90CrossRefGoogle Scholar