Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction

Int J Cardiovasc Imaging. 2015 Feb;31(2):379-87. doi: 10.1007/s10554-014-0559-9. Epub 2014 Oct 28.

Abstract

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.

MeSH terms

  • Aged
  • Cause of Death
  • Contrast Media
  • Female
  • Gadolinium DTPA
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Stroke Volume
  • Time Factors
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / mortality*
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Dysfunction, Right / therapy
  • Ventricular Function, Left
  • Ventricular Function, Right*

Substances

  • Contrast Media
  • gadodiamide
  • Gadolinium DTPA