Right Ventricular Involvement in Acute Left Ventricular Myocardial Infarction: Prognostic Implications of MRI Findings

OBJECTIVE. The purpose of this study was to investigate the prevalence and prognostic importance of the cardiac MRI finding of right ventricular involvement in patients with acute ST-segment elevation myocardial infarction (MI).

METHODS. Fifty patients (41 men, nine women; mean age, 58 ± 11 years) with first-ST-segment elevation MI underwent 1.5-T cardiac MRI immediately after successful percutaneous coronary intervention. The cardiac MRI protocol included steady-state free precession cine sequences for functional assessment of the left, right, and both ventricles and inversion recovery FLASH delayed enhancement sequences after contrast administration for the quantification of myocardial damage. The prevalence of right ventricular involvement detected with ECG and echocardiography was compared with the prevalence detected with cardiac MRI, which was the reference standard. Patients underwent follow-up for 32 ± 8 months.

RESULTS. Right ventricular involvement was diagnosed with cardiac MRI in 27 patients (54%): 14 of 30 patients (47%) with inferior ST-segment elevation MI and 13 of 20 patients (65%) with anterior ST-segment elevation MI. ECG and echocardiographic findings showed only moderate agreement with cardiac MRI findings in the detection of right ventricular involvement in inferior acute MI (kappa = 0.38). Patients with right ventricular involvement in anterior ST-segment elevation MI had larger infarcts (delayed enhancement, 25.9% ± 14.5% vs 11.4% ± 10.1%; p = 0.030), lower left ventricular ejection fraction (34.3% ± 8.2% vs 45.2% ± 9.5%; p < 0.015), and lower right ventricular ejection fraction (39.8% ± 6.6% vs 54.9% ± 8.8%; p < 0.001) than those without right ventricular involvement. In a multivariate logistic regression model, right ventricular involvement was a strong independent predictor (odds ratio, 15.8; 95% CI, 4–63%) of major cardiac adverse events.

CONCLUSION. Right ventricular involvement in ST-segment elevation MI is detected more frequently with cardiac MRI than with ECG and echocardiography and is an independent prognostic indicator. 

PMID: 20173133

Posted in Magnetic Resonance Imaging and tagged , , , , , , .

One Comment

  1. I enjoyed reading this paper! This will definetely make me look harder for RV involvement in cases of suspected MI (acute or chronic).

    I do have a question that I would like the authors to answer. In their methods they describe: “Inversion time was adjusted manually between 200 and 260 milliseconds for optimal nulling of the signal of normal LV myocardium. If RV delayed enhancement was suspected at visual inspection, inversion time was optimized separately for RV and LV myocardium.” In the current study, how different were the TI values for each ventricle?

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