Right Ventricular Injury in ST-Elevation Myocardial Infarction

Abstract

Background-Patients with right ventricular injury (RVI) complicating ST-elevation myocardial infarction (STEMI) haveimpaired prognosis, but it is unclear which patients are at risk of developing RVI. Cardiac magnetic resonance can identify these patients and might add important information on risk stratification, prognosis, and treatment. Aims were to determine the predictors and the prognostic significance of RVI assessed by wall motion abnormalities, edema, myocardial salvage index, and delayed enhancement in acute reperfused STEMI. Methods and Results-We studied 450 patients 1-4 days after primary angioplasty in STEMI. T2-weighted and delayed-enhancement cardiac magnetic resonance was used for visualizing edema and scar to calculate myocardial salvage index. Cine-imaging was performed to assess wall motion abnormalities, which, in combination with edema, were considered diagnostic for RVI. Patients with RVI were compared with matched patients with isolated left ventricular infarction. The primary end point was the occurrence of a major adverse cardiac event: a composite of death, reinfarction, and congestive heart failure after a median follow-up period of 20.9 months. RVI was present in 69 patients, and 41 of 69 showed myocardial necrosis. In a multivariable stepwise forward logistic regression analysis, a high RV myocardial mass (odds ratio, 2.06; 95% confidence interval, 1.

The challenges in the management of right ventricular infarction

“…31,32 of concomitant LV involvement, this study indicated that the mean optimal PWP, which corresponded to the maximum LV stroke work index in each patient, was 16 mmHg.…”

“…22 However, although the number of patients with RV infarction is small, these patients seem to have a higher risk of in-hospital mortality in the mechanical reperfusion era than during the fibrinolytic era. Figure 2 shows the changes in the in-hospital mortality rate and relative risk of RV infarction for in-hospital mortality between the fibrinolytic and mechanical reperfusion era; 8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] An increase in the relative risk of RV infarction from 2.29 (95% CI 1.67-3.14) to 2.98 (95% CI 1.41-6.31) also occurred during this period. The precise explanation for the paradox remains unknown.…”

The Systematic Evaluation of Identifying the Infarct Related Artery Utilizing Cardiac Magnetic Resonance in Patients Presenting with ST-Elevation Myocardial Infarction

“…[22] Contrast enhanced CMR imaging allows for superior identification of right ventricular infarcts. [23–27] Right ventricular injury is not limited to inferior infarcts, but can be found in anterior infarcts as well. [23] A recent study showed that the right ventricle was involved in 46% of patients with inferior infarcts and 30% of anterior infarcts.…”

Left ventricular remodeling in patients with right ventricular myocardial infarction

“…Эти изменения структуры стенки ЛЖ, объемов и формы (геометрии) камер сердца часто пред-шествуют клиническому проявлению синдрома сер-дечной недостаточности, являются предвестниками декомпенсации сердечной деятельности и отрица-тельно влияют на качество жизни и выживаемость больных [14]. При ИМ ПЖ восстановительный процесс менее сложен и сопровождается улучшением сокра-тительной способности ПЖ [15]. Функциональное вос-становление ПЖ уменьшает летальность больных ИМ нижней стенки ЛЖ и ПЖ [16].…”