title: Correlates of impaired global right ventricular function in patients with a reperfused acute myocardial infarction and without right ventricular infarction.
abstract: BACKGROUND
  The frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known.
  
  
  METHODS
  One hundred seven consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging (TDI) within 72 hours after a successful primary percutaneous coronary intervention to assess their RV function. Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55.
  
  
  RESULTS
  Global RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20-9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18-0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0-1.02; P = 0.039) were independently associated with the presence of global RV dysfunction.
  
  
  CONCLUSIONS
  In patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics.
authors: Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan.
authors: Shun-Yi
authors: SY
authors: Hsu
authors: Shang-Hung
authors: SH
authors: Chang
authors: Chih-Jen
authors: CJ
authors: Liu
authors: Jeng-Feng
authors: JF
authors: Lin
authors: Yu-Lin
authors: YL
authors: Ko
authors: Shih-Tsung
authors: ST
authors: Cheng
authors: Hsin-Hua
authors: HH
authors: Chou
authors: Heng-Chia
authors: HC
authors: Chang
mesh_terms: D004452:Echocardiography; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000150:complications* / Q000503:physiopathology