Right Ventricular Ischemic Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction
Open Access
- 5 October 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 122 (14), 1405-1412
- https://doi.org/10.1161/circulationaha.110.940254
Abstract
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. 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 P= 0.003). 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.Keywords
This publication has 27 references indexed in Scilit:
- Right Ventricular Edema Complicating Acute Inferior Myocardial Infarction as Demonstrated by T 2 -Weighted Cardiovascular Magnetic ResonanceCirculation: Cardiovascular Imaging, 2009
- Right Ventricular Dysfunction Assessed by Cardiovascular Magnetic Resonance Imaging Predicts Poor Prognosis Late After Myocardial InfarctionJournal of the American College of Cardiology, 2007
- Standardizing the Definition of Hyperenhancement in the Quantitative Assessment of Infarct Size and Myocardial Viability Using Delayed Contrast-Enhanced CMRJournal of Cardiovascular Magnetic Resonance, 2005
- Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudyHeart, 2005
- Diastolic dysfunction and left atrial volumeJournal of the American College of Cardiology, 2004
- Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the HeartCirculation, 2002
- Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular InfarctionThe New England Journal of Medicine, 1998
- Right Ventricular Infarction as an Independent Predictor of Prognosis after Acute Inferior Myocardial InfarctionThe New England Journal of Medicine, 1993
- Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease: Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarctionThe American Journal of Cardiology, 1978
- The arteries of the free ventricular walls in manThe Anatomical Record, 1960