Prognostic significance of right ventricular dysfunction in patients with acute inferior myocardial infarction and right ventricular involvement (original) (raw)
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1996
Right ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent longterm outcome in patients with chronic left-sided HF. We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≧ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences. RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters.
Predictors of Complications among Patients with Acute Inferior and Right Myocardial Infarction
Research in Cardiovascular Medicine, 2020
Introduction: Early recognition of acute right ventricular myocardial infarction (RVMI) is very crucial for the initiation of treatment to avoid complications. Objective: The objective of this study is to assess the predictors of complications in patients with acute inferior and RVMI. Patients and Methods: This prospective, single‑center study included 100 patients with acute inferior and RVMI presented within 6 h of symptoms onset. All patients received streptokinase as thrombolytic therapy. The patients had undergone conventional two‑dimensional echocardiography to assess LVEF, RVEF, RVFAC, and tricuspid annular plane systolic excursion (TAPSE), tissue Doppler to assess s`, e`, a` waves and myocardial performance index (MPI), and speckle tracking echocardiography to assess RV global longitudinal strain. All echocardiographic parameters were done within the first 12 h of admission and 2 months later. Results: Of 100 patients with acute RVMI; 27 patients had complications, the most common complication was atrioventricular block followed by cardiogenic shock. Mortality occurred in only one patient. On comparing the complicated and noncomplicated groups on admission, we revealed that; as regarding the clinical data, the female gender, presence of diabetes, lower systolic and diastolic blood pressure, and lower pulse were independent risk factors for occurrence of complications in RVMI with P < 0.029, 0.009, 0.004, 0.009, and 0.0001, respectively. Of the echo‑cardiographic parameters on admission, dilated RV, lateral S, MPI, TAPSE, and speckle were independent predictors for the occurrence of complications in patients with RVI with P < 0.005, <0.0001, 0.0001, 0.0001, and 0.011, respectively. We can use lateral s’, TAPSE, MPI, and speckle with cutoff value 7.9, 13.5, 0.765, −15.9, respectively, for prediction of in‑hospital complications in acute RVMI patients (P < 0.0001 for each parameter). Conclusion: Of the echo‑cardiographic parameters dilated RV, lateral S, MPI, TAPSE, and speckle were independent predictors for the occurrence of complications in patients with RVMI.
Journal of the American College of Cardiology, 2001
We sought to evaluate the prognostic impact of right ventricular (RV) myocardial involvement in patients with inferior myocardial infarction (MI). BACKGROUND There is uncertainty regarding the risk of major complications in patients with inferior MI complicated by RV myocardial involvement. Whether these complications are related to RV myocardial involvement itself or simply to the extent of infarction involving the left ventricle (LV) is also unknown.
Right ventricular stunning in inferior myocardial infarction
International Journal of Cardiology, 2009
Aim: To assess right ventricular (RV) function in patients with inferior myocardial infarction (IMI) and to observe changes following thrombolysis. Background: RV dysfunction occurs in 30% of patients with IMI. The extent of such involvement and its potential, recovery has not been determined. Methods: We studied 30 patients with acute IMI (age 56 ± 12 years), on admission, day 7 and day 30 post thrombolysis. No patient had clinical signs of RV failure. RV segmental function was assessed from free wall long axis and global function from filling and ejection velocities. Values were compared with 15 age-matched controls. Results: On admission, RV long axis amplitude, systolic and diastolic velocities were depressed (2.09 ± 0.39 vs 2.6 ± 0.3 cm, 8.18 ± 1.8 vs 10.0± 2.0 cm/s and 6.9 ± 2.7 vs 10.0± 2.5 cm/s, p b 0.01 for all) and global function impaired; reduced Z ratio (0.85 ± 0.07 vs 0.9 ± 0.04, p b 0.01), raised Tei index (0.49 ± 0.26 vs 0.3 ± 0.1, p b 0.001) and prolonged t-IVT (8.16 ± 3.9 vs 4.8 ± 2 s/m, p b 0.01) compared to controls.
European Journal of Heart Failure, 2010
Aims Despite improvement in prognosis for ST-elevation myocardial infarction (STEMI) patients, mortality remains high in STEMI patients presenting with cardiogenic shock (CS). Right ventricular (RV) dysfunction is an established independent predictor for adverse prognosis in STEMI patients without CS. The purpose of our study was to determine the prognostic value of RV dysfunction on admission in STEMI patients presenting in CS. Methods and results 292 consecutive STEMI patients with CS on admission were treated by primary percutaneous coronary intervention (PCI) from January 1997 through March 2005. RV function was assessed by measurement of tricuspid annular plane systolic excursion (TAPSE) on early echocardiography in 184 of 292 patients. RV dysfunction was defined as a TAPSE of ≤14 mm. RV dysfunction was present on early echocardiography in 70 of 184 patients (38%). The Kaplan-Meier estimate for overall 4-year survival was 57%. Kaplan-Meier estimates for 4-year survival in patients with and without RV dysfunction were 33% and 73%, respectively (p <0.001). Cox-regression analysis revealed a hazard ratio of 2.1 (95% CI 1.3-3.4, p=0.002) for RV dysfunction when adjusted for age, glucose and LVEF<40%. In patients with and without RV dysfunction, the right coronary artery (RCA) was the infarct-related artery (IRA) in 41% and 28% of patients, respectively (p=0.06). Conclusion In STEMI patients presenting with CS on admission and treated with primary PCI, RV dysfunction as assessed by echocardiography is an independent predictor for long term mortality.
Clinical correlates of acute right ventricular infarction in acute inferior myocardial infarction
International Journal of Cardiology, 1989
Right ventricular infarction was diagnosed on the basis of ST-segment elevation 2 1 mm in at least one right precordial lead (V,R-V,R) in 20 of 50 patients with first acute inferior myocardial infarction. Seventy five percent of these had ST elevation in 2 or more right precordial leads. Giddiness and hiccups were more common amongst such patients (P < 0.05). Signs of right ventricular dysfunction-raised jugular venous pressure (65%), Kussmaull's sign (45%), hypotension (without cardiogenic shock, 40%) and right-sided third sound (25%) in the absence of clinical left ventricular failure, were noted in 65% of such patients. Eleven patients had 2 or more of the above signs. ST elevation in 2 or more right precordial leads was found in 10 of these 11 patients. A more complicated course in the hospital characterised by bradyarrhythmias, hypotension and cardiogenic shock, combined with a greater mortality was seen in such patients. We conclude that the bedside diagnosis of haemodynamically significant right ventricular infarction can be made on the basis of a combination of clinical signs and ST elevation in 2 or more right precordial leads, even in units not equipped for bedside haemodynamic monitoring, echocardiography and radionuclide studies. This should lead to a better identification and management of such patients. inferior myocardial infarction [5] and when present may dominate the clinical picture and haemodynamic consequences. Secondly, its pres-India. ence not only means that appropriate therapy 0167-5273/89/$03.50 0 1989 Elsevier Science Publishers B.V. (Biomedical Division)
European Heart Journal: Acute Cardiovascular Care, 2013
Left ventricular (LV) dysfunction during and after hospitalization for ST-segment elevation myocardial infarction (STEMI) is associated with increased mortality. Whether baseline LV dysfunction impacts STEMI outcomes is not well studied. Furthermore, whether bivalirudin and paclitaxel-eluting stents (PES) are beneficial in patients with LV dysfunction is unknown. We studied the impact of left ventricular ejection fraction (LVEF) on outcomes of patients with STEMI in the HORIZONS-AMI trial. LVEF was determined in 2648 (73.5%) of 3602 enrolled STEMI patients, who were divided into three groups according to LV function: (1) severely impaired (LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40%); (2) moderately impaired (LVEF 40-50%); and (3) normal (LVEF ≥50%). Compared to patients with normal LV function, those with severely impaired LVEF had higher 1-year rates of net adverse clinical events (27.1 vs. 14.2%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), major adverse cardiovascular events (20.7 vs. 9.5%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), cardiac death (10.6 vs. 1.2%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001), and non-coronary artery bypass graft major bleeding (12.5 vs. 6.6%, p=0.001), differences which persisted after adjustment for baseline characteristics. Among patients with LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40%, treatment with bivalirudin compared to heparin+GPIIb/IIIa inhibitors resulted in reduced 1-year mortality (5.8 vs. 18.3%, p=0.007). Patients with LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40% receiving PES rather than bare metal stents had lower rates of 1-year ischaemia-driven target lesion revascularization (2.9 vs. 12.6%, p=0.02) and reinfarction (4.5 vs. 14.7%, p=0.03). Among patients with STEMI undergoing primary percutaneous coronary intervention, adverse events are markedly increased in those with LVEF &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;40% during the index revascularization procedure. Nevertheless, these high-risk patients experience substantial clinical benefits from bivalirudin and PES.