title: Right ventricular dysfunction assessed by cardiovascular magnetic resonance imaging predicts poor prognosis late after myocardial infarction.
abstract: OBJECTIVE
  We sought to determine whether right ventricular (RV) function late after myocardial infarction (MI) impacts long-term prognosis.
  
  
  BACKGROUND
  Right ventricular failure predicts early mortality in patients with acute MI. The prognostic impact of RV function late after MI is not well defined. Accordingly, we determined whether RV dysfunction late after MI influences survival beyond traditional risk predictors, including patient age, left ventricular ejection fraction (LVEF), and infarct size.
  
  
  METHODS
  We studied 147 consecutive patients >30 days after MI (mean age of infarct 6.7 +/- 8.2 years) who were referred for contrast-enhanced cardiovascular magnetic resonance imaging. We assessed hazard ratios for death by RV ejection fraction (RVEF). The association of RVEF with mortality adjusted to traditional risk predictors was examined by using multivariable Cox proportional hazards regression models.
  
  
  RESULTS
  A total of 26 deaths occurred during a median follow-up of 17 months (range 6 to 53 months). By univariable analysis, RVEF <40% was strongly associated with mortality (unadjusted hazard ratio 4.02; p = 0.0007). By multivariable analysis that adjusted for patient age, left ventricular (LV) infarct size, and LVEF, RVEF <40% remained a significant independent predictor of mortality (adjusted hazard ratio 2.86; p = 0.03).
  
  
  CONCLUSIONS
  Right ventricular ejection fraction quantified late after MI is an important predictor of prognosis adjusted for patient age, LV infarct size, and LVEF. Accordingly, evaluation of RVEF using cardiovascular magnetic resonance imaging can improve risk-stratification and potentially refine patient management after MI.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
authors.forename: H Glenn
authors.initials: HG
authors.lastname: Reynolds
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Brown
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology*