title: Right ventricular ischemic injury in patients with acute ST-segment elevation myocardial infarction: characterization with cardiovascular magnetic resonance.
abstract: BACKGROUND
  Experimental data show that the right ventricle (RV) is more resistant to ischemia than the left ventricle. To date, limited data are available in humans because of the difficulty of discriminating reversible from irreversible ischemic damage. We sought to characterize RV ischemic injury in patients with reperfused myocardial infarction using cardiovascular magnetic resonance.
  
  
  RESULTS
  In 3 tertiary centers, 242 consecutive patients with reperfused acute ST-segment elevation myocardial infarction were studied with cardiovascular magnetic resonance at 1 week and 4 months after myocardial infarction. T2-weighted and postcontrast cardiovascular magnetic resonance scans were used to depict myocardial edema and late gadolinium enhancement, respectively. Early after infarction, RV edema was common (51% of patients), often associated with late gadolinium enhancement (31% of patients). Remarkably, RV edema and late gadolinium enhancement were found in 33% and 12% of anterior left ventricular infarcts, respectively. Baseline regional and global RV functions were inversely related to the presence and extent of RV edema and RV late gadolinium enhancement. At follow-up, a significant decrease in frequency (25/242 patients; 10%) and extent of RV late gadolinium enhancement was observed (P<0.001). With the use of multivariable analysis, the presence of RV edema was an independent predictor of RV global function improvement during follow-up (β-coefficient=0.221, P=0.003).
  
  
  CONCLUSIONS
  Early postinfarction RV ischemic injury is common and is characterized by the presence of myocardial edema, late gadolinium enhancement, and functional abnormalities. RV injury is not limited to inferior infarcts but is commonly found in anterior infarcts as well. Cardiovascular magnetic resonance findings suggest reversibility of acute RV dysfunction with limited permanent myocardial damage at 4-month follow-up.
authors.affiliation: Department of Radiology, Medical Imaging Research Center, UZ Leuven, Herestraat 49, Leuven, Belgium.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
authors.forename: Javier
authors.initials: J
authors.lastname: Ganame
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Todiere
authors.forename: Rocco
authors.initials: R
authors.lastname: Donato
authors.forename: Valeria
authors.initials: V
authors.lastname: Siciliano
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Matteo
authors.initials: M
authors.lastname: Mangia
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Strata
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
mesh_terms: D000368:Aged; D003287:Contrast Media; D003925:Diabetic Angiopathies / Q000473:pathology / Q000503:physiopathology; D004487:Edema / Q000473:pathology / Q000503:physiopathology; D004489:Edema, Cardiac / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000473:pathology* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D012044:Regression Analysis; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology
chemical_list: D003287:Contrast Media