title: Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction.
abstract: Prognostic implication of right ventricular dysfunction and infarction scar in the chronic phase of the myocardial infarction has been little analyzed. In 299 consecutive patients (age 63 ± 11 years) with >3 months old myocardial infarction, we quantified right and left ventricular volumes and ejection fractions by cine cardiac magnetic resonance, and right and left ventricular scar tissue by late gadolinium enhancement. During follow-up (median, 2.4 years) cardiac events (cardiac-related deaths or appropriate intra-cardiac defibrillator shocks) occurred in 21 patients. Right ventricular systolic dysfunction (ejection fraction lower the reference mean values-2 SD) was present in 67 patients (22 %), right ventricular late gadolinium enhancement was observed in 15 patients (5 %). After adjustment for left ventricular end-diastolic volume, wall motion score index, and global extent of late gadolinium enhancement, right ventricular dysfunction was an independent and incremental predictor of cardiac events (p = 0.0053), while right ventricular scar tissue extent was not. Right ventricular dysfunction is an independent and incremental predictor of cardiac events also in the chronic phase of the myocardial infarction. In these patients, right ventricular dysfunction does not necessarily mean right ventricular infarction scar, but likely reflects the effects of hemodynamic and biohumoral factors.
authors.affiliation: Institute of Clinical Physiology, CNR, Via Moruzzi, 1, 56124, Pisa, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Valeria
authors.initials: V
authors.lastname: Siciliano
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: Aquaro
authors.forename: Daniele
authors.initials: D
authors.lastname: De Marchi
authors.forename: Daniele
authors.initials: D
authors.lastname: Rovai
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
mesh_terms: D000368:Aged; D002423:Cause of Death; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA