Prompt return to normal of depressed right ventricular ejection fraction in acute inferior infarction.

Steele, Peter; Kirch, Dennis; Ellis, James H.; Vogel, Robert A.; Battock, Dennis

doi:10.1136/hrt.39.12.1319

Cited by 86 publications

(21 citation statements)

References 18 publications

(1 reference statement)

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“…In fact, RV function is more reversible than LV function and recovers within 2-10 days after MI onset. 18,19 First, because the RV is more compliant than the LV, the Frank-Starling mechanism may work more efficiently and favorably toward ventricular remodeling in the RV compared with the LV. Second, RV function is compensated by hyperkinesis of the preserved interventricular septum, which is free of ischemia because it is independently supplied by the left anterior descending artery.…”

Section: Discussionmentioning

confidence: 99%

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

Shiraki

Yokozuka

Negishi

et al. 2010

Circ J

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Background: Right ventricular myocardial infarction (RVMI) is the major cause of hypotension and/or shock (HpS) after acute inferior myocardial infarction (inferior AMI). It is, however, unclear how RVMI affects the acute hemodynamic course. Methods and Results:In the present study, 153 patients with inferior AMI caused by right coronary artery occlusion were examined. Associations between in-hospital outcome and HpS before admission (preER-HpS) or HpS after admission (postER-HpS) were assessed using multivariate logistic regression analysis. Multivariate analysis was also conducted to determine a predictor for postER-HpS, including clinical findings in the emergency room as independent variables. HpS developed in 48.4% of patients with inferior AMI. Patients with RVMI more frequently had HpS than their counterparts in the first 6 h after infarction onset. RVMI was, however, not associated with preER-HpS, but was independently with postER-HpS (odds ratio (OR): 10.1; 4.0-27.7), whereas left ventricular failure was associated with preER-HpS, but not with postER-HpS. Furthermore, RVMI (OR: 9.4; 3.6-27.1) identified at presentation predicted postER-HpS.Conclusions: Independent of concomitant left ventricular involvement, RVMI was significantly associated with postER-HpS, but not with preER-HpS. These findings highlight the importance of identifying RVMI immediately after admission in the setting of inferior AMI. (Circ J 2010; 74: 148 - 155)

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Section: Discussionmentioning

confidence: 99%

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

Shiraki

Yokozuka

Negishi

et al. 2010

Circ J

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“…Since then, right ventricular systolic func tion has been systematically evaluated in the postinfarction phase [15]. Steele et al [16] reported that right ventricular ejection frac tion returned to normal from an initial de pressed value within 3 days of an acute infe rior myocardial infarction in 10 of 11 pa tients. Klein et al [17] reported the follow up radionuclide angiographic results in 37 patients who initially had evidence of de creased right ventricular ejection fraction and wall motion abnormalities.…”

Section: Right Ventricular Infarction In the Absence O F Thrombolyticmentioning

confidence: 99%

Early Thrombolytic Therapy Does Not Enhance the Recovery of the Right Ventricle in Patients with Acute Inferior Myocardial Infarction and Predominant Right Ventricular Involvement

Roth¹,

Miller²,

Kaluski³

et al. 1990

Cardiology

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In this study we report the effects of early thrombolytic therapy on the recovery of the right ventricle after an acute myocardial infarction. Sixty-five patients presenting with their first inferior myocardial infarction and predominant right ventricular involvement were consecutively treated as follows: group A (20 patients) conservatively (without thrombolytic therapy), group B (19 patients) with streptokinase and group C (26 patients) with recombinant tissue type plasminogen activator. Coronary angiography was performed within 72 h after admission in 52 patients (10 of group A, 18 of group B and in 24 patients of group C) followed by transluminal coronary angioplasty in 26. All groups had similar characteristics except for a higher mean age in group A. Within 3 months, a remarkable improvement in right ventricular function and a major increase in ejection fraction was observed for all three patient groups. Improvement of right ventricular function was more prominent in patients with residual flow through the infarct-related artery. The beneficial course was comparable in all the groups, unaffected by the type of medical treatment applied, or by the performance of coronary angioplasty. No further significant change occurred beyond this period. Thus, early thrombolytic therapy does not augment the generally favorable course of recovery of the right ventricle from acute infarction.

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“…First, improved right ventric ular systolic function in the subacute phase may alter the filling pattern by lowering the right ventricular filling pressures and by decreasing the size of the dilated right ventricle. Right ventricular ejection fraction has been scintigraphically suggested to improve in a relatively short time after the onset of right ventricular infarction [25][26][27], In our study, although in the acute phase group 1 patients suffered from a low output state with moderate to severe hypotension, all of the patients recovered from this state in the subacute phase. Therefore, hemodynamic improvement might manifest the inherent pattern of ab normal relaxation.…”

Section: Comparison Of the Right Ventricular Filling Pattern In The Smentioning

confidence: 47%

Doppler Echocardiographic Assessment of Right Ventricular Filling Characteristics in Hemodynamically Significant Right Ventricular Infarction

Motomiya¹,

Tejima²,

Nomura³

1992

Am J Noninvas Cardiol

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To evaluate the right ventricular filling characteristics in hemodynamically significant right ventricular infarction, 16 patients with acute inferior myocardial infarction within 48 h after onset were studied with pulsed Doppler echocardiography. The patients were subdivided into two groups on the basis of hemodynamic criteria for right ventricular infarction. Group 1 consisted of 7 patients with right ventricular infarction and with a noncompliant pattern in right atrial pressure recording. Group 2 consisted of 9 patients without right ventricular infarction. Peak flow velocities of right ventricular filling in early diastole (E) and during atrial systole (A), A to E ratio (A/E) and deceleration time (DT) of the E wave were determined. In group 1, A and A/E (18.6 ± 2.0 cm/s and 0.43 ± 0.15, respectively) were significantly lower (p < 0.01) than in normal (31.1 ± 7.0 cm/s and 0.71 ± 0.09, respectively) or group 2 patients (42.2 ± 7.1 cm/sand 1.00 ± 0.17, respectively). DT ingroup 1 (104 ± 46 ms) was markedly shorter (p < 0.01) than in normal (186 ± 26 ms) or group 2 patients (245 ± 62 ms). Comparisons of E and A between the acute and subacute phases in group 1 revealed that E decreased from 46.3 ± 12.4 to 36.8 ± 13.1 cm/s (p < 0.05) and A increased from 18.6 ± 2.0 to 38.0 ± 8.0 cm/s (p < 0.01). Thus A/E in group 1 was significantly lower (p <0.01) in the acute than in the subacute phase (0.43 ± 0.15 vs. 1.11 ± 0.31). DT in group 1 was significantly shorter (p < 0.01) in the acute than in the subacute phase (104 ± 46 vs. 204 ± 42 ms). These results indicate that patients with hemodynamically significant right ventricular infarction have a characteristic Doppler echocardiographic right ventricular filling pattern in the acute phase with an increased E, a decreased A/E and shortened DT. This Doppler pattern may reflect restrictive physiology of the right heart in patients with hemodynamically significant right ventricular infarction.

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Prompt return to normal of depressed right ventricular ejection fraction in acute inferior infarction.

Cited by 86 publications

References 18 publications

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

Acute Impact of Right Ventricular Infarction on Early Hemodynamic Course After Inferior Myocardial Infarction

Early Thrombolytic Therapy Does Not Enhance the Recovery of the Right Ventricle in Patients with Acute Inferior Myocardial Infarction and Predominant Right Ventricular Involvement

Doppler Echocardiographic Assessment of Right Ventricular Filling Characteristics in Hemodynamically Significant Right Ventricular Infarction

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