Predictors of right ventricular dysfunction in patients with coronary artery disease and reduced left ventricular ejection fraction.
BACKGROUND
The frequency and determinants of right ventricular (RV) dysfunction in patients with coronary artery disease (CAD) and reduced left ventricular (LV) function have not been thoroughly investigated.


METHODS
The study population consists of 80 consecutive patients, invasively evaluated at our centre. Entry criteria were: LV ejection fraction < 45%; angiographic evidence of obstructive CAD; disease history of more than 3 months' duration. Exclusion criteria were: recent myocardial infarction and unstable angina. All patients underwent cardiac catheterization with coronary, LV and RV angiography. RV dysfunction was defined as a RV ejection fraction < 35%, which corresponds to the mean-three standard deviations of controls.


RESULTS
Sixty-five patients (81%) had multi-vessel disease and 57 (71%) had a previous myocardial infarction. Mean LV ejection fraction was 31 +/- 8%. Mean RV ejection fraction was 46 +/- 11%. Right ventricular dysfunction was present in 14 patients (18%). An occluded proximal right coronary artery was associated with significantly lower RV ejection fraction (38 +/- 12% versus 47 +/- 10%; P = 0.009) but not LV ejection fraction (30 +/- 8% versus 32 +/- 9%; P = 0.444). However, at multivariate analysis, only pulmonary hypertension was an independent significant predictor of RV dysfunction (P < 0.001; OR: 1.13; CI: 1.06 -1.22).


CONCLUSIONS
Right ventricular dysfunction in patients with chronic ischaemic LV dysfunction is detected in less than 20% of cases. Proximal right coronary artery occlusion is associated with a reduced RV ejection fraction. However, the role of right coronary artery disease is overwhelmed by the haemodynamic burden of pulmonary hypertension, which represents the only independent predictor of RV dysfunction in our population.
La Vecchia
Luigi
L
Department of Cardiology, S Bortolo Hospital, Vicenza, Italy. lavecchia.cardiovi@libero.it
Luca Spadaro
Gian
G
Paccanaro
Mariemma
M
Favero
Luca
L
Zanolla
Luisa
L
Vincenzi
Paolo
P
Martini
Manuela
M
Fontanelli
Alessandro
A
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D004108:Dilatation, Pathologic / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D013318:Stroke Volume / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000503:physiopathology*