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Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction.
MedLine Citation:
PMID:  23392056     Owner:  NLM     Status:  Publisher    
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. MATERIALS AND 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.
Shun-Yi Hsu; Shang-Hung Chang; Chih-Jen Liu; Jeng-Feng Lin; Yu-Lin Ko; Shih-Tsung Cheng; Hsin-Hua Chou; Heng-Chia Chang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-6
Journal Detail:
Title:  Journal of investigative medicine : the official publication of the American Federation for Clinical Research     Volume:  -     ISSN:  1708-8267     ISO Abbreviation:  J. Investig. Med.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9501229     Medline TA:  J Investig Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the *Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan; †Tzu Chi University College of Medicine, Hualien, Taiwan; and ‡Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
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