Right ventricular ischemic injury in patients with acute ST-segment elevation myocardial infarction: characterization with cardiovascular magnetic resonance.
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.
Masci
Pier Giorgio
PG
Department of Radiology, Medical Imaging Research Center, UZ Leuven, Herestraat 49, Leuven, Belgium.
Francone
Marco
M
Desmet
Walter
W
Ganame
Javier
J
Todiere
Giancarlo
G
Donato
Rocco
R
Siciliano
Valeria
V
Carbone
Iacopo
I
Mangia
Matteo
M
Strata
Elisabetta
E
Catalano
Carlo
C
Lombardi
Massimo
M
Agati
Luciano
L
Janssens
Stefan
S
Bogaert
Jan
J
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
D003287:Contrast Media