Right Ventricular Involvement In Patients Research Articles

Multimodality Imaging Evaluation to Detect Subtle Right Ventricular Involvement in Patients with Acute Myocarditis and Preserved Left Ventricular Ejection Fraction

Background: Evaluation of the right ventricle (RV) in patients with acute myocarditis (MY) remains challenging with both 2D transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). We examined the incremental diagnostic value of CMR feature tracking (FT) to evaluate RV involvement in patients with myocarditis. Methods: We enrolled 54 patients with myocarditis and preserved left ventricle (LV) ejection fraction (EF). The CMR protocol included T2-weighted images for edema detection and late gadolinium enhancement (LGE) images. Global longitudinal strain (GLS) of the left ventricle (LV) and RV free wall strain (CMR-FWS) were obtained with CMR-FT. We identified 34 patients (62%) with inferior and lateral segment (IL-MY) involvement and 20 (38%) noIL-MY in case of any other myocardial segment involved. Here, 20 individuals who underwent CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as the control population. Results: TTE and CMR showed normal RV function in all patients without visible RV involvement at the LGE or T2-weighted sequences. At CMR, LV-GLS values were significantly lower in patients with MY compared to the control group (median −19.0% vs. −21.0%, p = 0.029). Overall, CMR RV-FWS was no different between MY patients and controls (median −21.2% vs. −23.2 %, p = 0.201) while a significant difference was found between RV FWS in IL-MY and noIL-MY (median −18.17% vs. −24.2%, p = 0.004). Conclusions: CMR-FT has the potential to unravel subclinical RV involvement in patients with acute myocarditis, specifically in those with inferior and lateral injuries that exhibit lower RV-FWS values. In this setting, RV deformation analysis at CMR may be effectively implemented for a comprehensive functional assessment.

Implications of structural right ventricular involvement in patients with hypertrophic cardiomyopathy.

In the clinical practice, the right ventricular (RV) manifestations have received less attention in hypertrophic cardiomyopathy (HCM). This paper aimed to evaluate the risk prediction value and genetic characteristics of RV involvement in HCM patients. A total of 893 patients with HCM were recruited. RV hypertrophy, RV obstruction, and RV late gadolinium enhancement were evaluated by echocardiography and/or cardiac magnetic resonance. Patients with any of the above structural abnormalities were identified as having RV involvement. All patients were followed with a median follow-up time of 3.0 years. The primary endpoint was cardiovascular death; the secondary endpoints were all-cause death and heart failure (HF)-related death. Survival analyses were conducted to evaluate the associations between RV involvement and the endpoints. Genetic testing was performed on 669 patients. RV involvement was recognized in 114 of 893 patients (12.8%). Survival analyses demonstrated that RV involvement was an independent risk factor for cardiovascular death (P = 0.002), all-cause death (P = 0.011), and HF-related death (P = 0.004). These outcome results were then confirmed by a sensitivity analysis. Genetic testing revealed a higher frequency of genotype-positive in patients with RV involvement (57.0% vs. 31.0%, P < 0.001), and the P/LP variants of MYBPC3 were more frequently identified in patients with RV involvement (30.4% vs. 12.0%, P < 0.001). Logistic analyses indicated the independent correlation between RV involvement and these genetic factors. RV involvement was an independent risk factor for cardiovascular death, all-cause death and HF-related death in HCM patients. Genetic factors might contribute to RV involvement in HCM.

Right-ventricular involvement in acute myocarditis assessed by cardiac magnetic resonance feature tracking

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION the prevalence of right ventricular (RV) involvement in acute myocarditis (aMY) has been poorly investigated. Actually, RV evaluation may be difficult in echocardiography and scar detection as well as the presence of edema in cardiovascular magnetic resonance (CMR) may be challenging due to small RV wall thickness. We sought to examine the incremental diagnostic value of CMR feature tracking (FT) in RV strain-analysis for patients with aMY. METHODS all consecutive patients with clinically suspected aMY were enrolled in our study. Inclusion criteria were: 1) new ECG abnormalities 2) myocardial cytolysis markers and 3) absence of angiographically detectable coronary artery disease. Exclusion criteria included poor cine image quality caused by respiratory motion and arrhythmias. All patients underwent transthoracic echocardiography (TTE) and CMR within hospitalization on a 3T scan. CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis and T2 weighted images. The definite diagnosis was made when 2 or more Lake Louise criteria were fulfilled. FT analysis of the left ventricle (LV) and RV was performed using the Tissue Tracking Module to obtain LV and RV global longitudinal (RV-GLS) strain data. 20 sex and aged matched individuals who underwent to CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as control population. RESULTS 52 patients were included in the study, mean age was 36 ± 17 years, three patients were female (6%). Mean LV ejection fraction (EF) was 56,2 ± 7,2 and mean end-diastolic volume indexed (EDVi) was 62,52 ± 19,02 ml/mq. 10 patients (19%) had impaired EF with mean values of 44,6 ± 6,1%. All patients have normal RV function evaluated in TTE considering tricuspid annular plane systolic excursion (TAPSE) (22,7 ± 2,4mm). No kinetic abnormalities were reported. All patients underwent CMR within 3 ± 1 days. Normal RV-EF, normal volumes and no RV kinetic abnormalities were reported in all cases also in CMR examination. aMY was confirmed in all patients with the presence of myocardial oedema and subepicardial late gadolinium enhancement (LGE). Inferior segments were involved in 28 patients (54%), lateral segments in 19 patients (37%), septal segments in 7 patients (13%) and anterior segments in 15 patients (29%). RV-GLS was -21,5 ± 5,6% which was not significantly different from control population (-23,01 ± 3,63; p value= 0,201). Globally, 34 patients (65%) had an aMY involving inferior and lateral segments. In this subgroup, RV-GLS was significantly lower compared to other aMY (-19,8 ± 5,7 vs -23,9 ± 4,6 p value = 0,047) and compared to control population (-19,8 ± 5,7 vs -23,01 ± 3,6 p value= 0,032). CONCLUSIONS Despite normal RV function detected in both TTE and CMR, patients with infero-lateral aMY have lower values of RV longitudinal strain. CMR-FT RV strain analysis has proven to be a useful tool in detecting subclinical RV involvement in patients with aMY. Abstract Figure. CMR Right Ventricle GLS

Role of 2-dimensional speckle tracking echocardiography in diagnosis of right ventricular involvement in patients with inferior wall myocardial infarction undergoing primary percutaneous coronary intervention.

Diagnosis of right ventricular (RV) infarction in the setting of acute inferior wall myocardial infarction (IWMI) has important prognostic implications. We sought to assess the role of 2-D speckle tracking echocardiography (2-D STE) for the assessment of RV involvement in acute IWMI.We included 100 consecutive patients with a diagnosis of recent IWMI, of which 73 had an RCA culprit lesion, undergoing primary percutaneous coronary intervention (PPCI). Patients (n = 73) were classified into 2 groups based on angiographic evidence of RV involvement (lesions proximal to or involving RV branch versus distal lesions). Echocardiographic features of RV dysfunction were assessed using conventional 2-D echocardiographic, and Tissue Doppler parameters as well as 2-D speckle tracking echocardiography.Out of the 73 patients, 42 had RCA lesion proximal to or involving RV branch, while 31 patients had RCA culprit distal to RV branch. Among different parameters assessing RV function, only RV-FWLS was significantly lower among the former group (- 14.2 ± 4.6 vs. - 17.7 ± 4.2, p = 0.026). Receiver-operator characteristic (ROC) analysis showed that RV-FWLS had the strongest discriminatory capability to identify RV infarction (AUC = 0.7, p = 0.02, 95% CI 0.53-0.78). A cut-off value of RV-FWLS ≤ - 20.5% had 88% sensitivity and 33% specificity for diagnosis of RV infarction.STE-derived RV-FWLS with cutoff ≤ - 20.5% could be a reliable and promising tool for prediction of RV involvement in the setting of acute IWMI, which could guide proper risk stratification and tailored acute management strategy.

Prevalence, functional characteristics, and clinical significance of right ventricular involvement in patients with hypertrophic cardiomyopathy

We sought to investigate the prevalence, functional characteristics, and clinical significance of right ventricular (RV) involvement in patients with hypertrophic cardiomyopathy (HCM). A total of 256 patients with HCM who underwent both cardiac magnetic resonance (CMR) imaging and transthoracic echocardiography within 6 months of each other were retrospectively analysed. RV involvement was defined as an increased RV wall thickness ≥ 7 mm on CMR in the segments of the RV free wall. Primary outcomes were defined as the composite of all-cause death, heart transplantation, and unplanned cardiovascular admission. Thirty-seven (14.4%) patients showed RV involvement. Patients with RV involvement showed a significantly higher left ventricular (LV) maximal wall thickness and left atrial volume index. Multivariate Cox model revealed that RV involvement was independently associated with primary outcomes (HR: 2.30, p = 0.024). In a subgroup analysis of patients with speckle tracking echocardiography (n = 190), those with RV involvement had significantly more impaired RV strain, which was independently associated with primary outcomes. RV involvement in patients with HCM correlated with more advanced LV structure and biventricular dysfunction, suggesting an indicator of severe HCM. RV involvement and impaired RV strain have a prognostic value related to clinical adverse events in patients with HCM.

Assessment of Left and Right Ventricular Involvement in Patients with Chronic Obstructive Pulmonary Disease with Special Reference to Echocardiography

Assessment of Left and Right Ventricular Involvement in Patients with Chronic Obstructive Pulmonary Disease with Special Reference to Echocardiography

P1248Characteristics and clinical significance of right ventricular involvement in patients with hypertrophic cardiomyopathy

Abstract Background A few studies have demonstrated bi-ventricular hypertrophy in hypertrophic cardiomyopathy (HCM). However, clinical significance of HCM with right ventricular (RV) involvement has not been fully established. Therefore, we aimed to investigate the structural characteristics and clinical significance of RV hypertrophy in patients with HCM. Methods In a single center, large HCM registry, 256 patients with HCM who underwent both cardiac magnetic resonance (CMR) and transthoracic echocardiography within 6 months were retrospectively analyzed. RV involvement was defined as increased RV wall thickness &gt;7 mm on CMR in any segments of RV free wall and apex. Patients who had evidence of significant RV pressure overload (RV systolic pressure &gt;50mmHg) or had undergone septal myectomy were excluded. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for cardiovascular disease. Results Among 256 patients, 41 (16%) showed RV involvement. During follow-up period (median 1099 days), 32 cardiovascular outcomes (3 cardiovascular death and 29 cardiovascular hospitalization) were occurred. Patients with RV involvement showed a significantly higher left ventricular (LV) thickness (23.8±5.8 vs. 21.2±5.0 mm, p=0.004), more advanced diastolic dysfunction, and larger left atrial volume index (LAVI, 48.5±20.3 vs. 40.2±14.9 mm/m2, p=0.016) compared to those without RV involvement. In multivariate cox regression analysis, presence of RV involvement (HR: 4.21, 95% CI: 1.99–8.90, p&lt;0.001) and LV ejection fraction &lt;50% (HR: 4.29, 95% CI: 1.37–13.43, p=0.012) were independently associated with cardiovascular outcomes. The Kapan-Meier curve showed that there was a significant decrease in probability of cardiovascular outcomes-free survival in patients with RV involvement (p=0.007) after using 1:1 propensity score matching (n=82) to adjust for age, sex, LV ejection fraction, LV maximal wall thickness, LAVI, and RV systolic pressure than patients without RV involvement (Figure 1). Figure 1 Conclusion RV involvement in patients with HCM were not rare (16%). Patients with RV involvement showed more advanced LV structure and dysfunction, suggesting an indicator of severe HCM. RV involvement in HCM has clinical significance related to cardiovascular outcomes.

Role of Right Ventricular Strain Measured by Two-Dimensional Echocardiography in the Diagnosis of Cardiac Amyloidosis

Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes. Seventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value. LV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9±2.9% in ALCA, 12.5±3.8% in TTRwt, 14.9±2.7% in TTRm, and 21.9±2.6% in control subjects [P<.01]; free-wall RV longitudinal strain: 13.1±6.8%, 14.9±4.5%, 17.2±3.4%, and 22.1±3.1%, respectively [P<.01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1±0.2, 0.8±0.2, 0.9±0.1, and 0.7±0.1, respectively [P<.001]; RV AR: 1.1±0.2, 0.6±0.2, 0.6±0.1, and 0.6±0.1, respectively [P<.001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA. RV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.

Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy.

BackgroundImpaired right ventricular (RV) function indicates RV involvement in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess RV function at rest and during exercise in HCM patients and to examine the association between impaired RV mechanics and exercise capacity.Methods and ResultsA total of 76 HCM patients (48 without and 28 with RV hypertrophy) and 30 age‐ and sex‐matched controls were prospectively recruited. RV function was evaluated at rest and during semisupine bicycle exercise by conventional echocardiography and 2‐dimensional speckle‐tracking imaging. Exercise capacity was measured by metabolic equivalents. RV functional reserve was calculated as the difference of functional parameters between peak exercise and rest. Compared with controls, HCM patients had significantly higher RV free wall thickness, lower RV global longitudinal strain and RV free wall longitudinal strain at rest and during exercise, and reduced RV systolic functional reserve. Compared with those with HCM without RV hypertrophy, patients with HCM with RV hypertrophy had lower metabolic equivalents. Among HCM patients, an effective correlation was seen between exercise capacity and peak exercise RV global longitudinal strain and peak exercise RV free wall longitudinal strain. A binary logistic regression model revealed several independent predictors of exercise intolerance in HCM patients, but receiver operating characteristic curve analysis indicated exercise RV global longitudinal strain had the highest area under the curve for the prediction of exercise intolerance in HCM patients.Conclusions HCM patients have RV dysfunction and reduced contractile reserve. Exercise RV global longitudinal strain correlates with exercise capacity and can independently predict exercise intolerance. In addition, patients with HCM with RV hypertrophy exhibit more reduced exercise capacity, suggesting more severe disease and poorer prognosis.

In-Hospital Outcome of Right Ventricular Involvement in Patients with Acute Inferior Myocardial Infarction

Aim of the Work: To study the in-hospital outcome of right ventricular involvement (RVI) in patients with acute inferior myocardial infarction (AIMI). Material and Methods: We conducted a short prospective study carried out on 60 patients with AIMI, classified into two groups; patients group: AIMI with RVI; inferior or infroposterior acute myocardial infarction (AMI) with ≥ 0.1 mV V4R elevation, and control group: AIMI without RVI; inferior or infroposterior AMI without ≥ 0.1 mV V4R elevation. We followed up both groups during their hospital stay and compared both groups regarding development of complications and mortality. Results: Patients with RVI in AIMI had more admission hyperglycaemia (268.80 ± 81.88 mg/dl vs. 219.80 ± 98.40 mg/dl, P value = 0.003), less incidence of complete ST elevation resolution (STR) (60.8% vs. 80.6%, p value = 0.032), more arrhythmic complications (3rd heart block [HB]: 6.7% vs. 0.0%, p value = 0.042, atrial fibrillation [AF]: 10.0% vs. 2.0%, p value = 0.036). Conclusions: Patients with RVI in AIMI had worse in-hospital outcome than patients without RVI in the form of more admission hyperglycemia, less incidence of complete STR and more arrhythmic complications.

In Hospital Outcome of Subclinical Right Ventricular Involvement in Patients with Acute Inferior Myocardial Infarction

Objectives: This study aimed to study the in hospital outcome of subclinical right ventricular involvement (ScRVI)in patients with acute inferior wall myocardial infarction(AIMI). Patients and Methods: We conducted a short prospective studycarried out on 60 patients with acute inferior myocardial infarction, classified into two groups; patients group: AIMIwith ScRVI; inferior or infroposterior acute myocardial infarction (AMI)patients with ≥ 0.1 mV V4R elevation, and control group: AIMI without ScRVI; inferior or infroposterior AMI patients without ≥ 0.1 mV V4R elevation. We followed up both groups during their hospital stay and compared both groups regarding development of complications and mortality. Results: Patients with ScRVI in AIMIhad more admission hyperglycaemia (268.80 ± 81.88 mg/dl vs. 219.80 ± 98.40 mg/dl, P value =0.003), less incidence of complete ST elevation resolution (STR) (60.8 %vs. 80.6%, p value = 0.032), more arrhythmic complications (3 rd heart block [HB]: 6.7% vs. 0.0%, p value = 0.042, atrial fibrillation [AF]: 10.0% vs. 2.0%, p value = 0.036). Conclusions: We concluded that patients with ScRVI in AIMI had worse in hospital outcome than patients without ScRVI.

P.5.16 Predominant right ventricular involvement in patients with laminopathies

We present here five patients carrying LMNA gene mutations with a non previously reported cardiac phenotype. In addition to variable muscular phenotype (Emery-Dreifuss muscular dystrophy or limb girdle weakness without contractures) and conduction defects/arrhythmias usually observed in cardio-laminopathy, all patients had evidence for a prominent right ventricular cardiomyopathy that arose before any significant left ventricular involvement and 3 developed severe tricuspid valve regurgitation. The fatal outcome of the 2 patients who were offered tricuspid valve replacement and died soon after, suggest that heart transplantation should be proposed early in these patients. In conclusion, in familial or sporadic patients presenting a right ventricular failure with conduction defects and arrhythmias, with or without tricuspid insufficiency, LMNA gene should be considered.

Prevalence and clinical significance of right ventricular involvement in patients with tako-tsubo cardiomyopathy

Purpose: Tako-tsubo cardiomyopathy (TTC) is a transient form of acute heart failure. Besides ballooning of the left ventricle (LV), some patients develop wall motion abnormalities of the right ventricle (RV). This study assessed the prevalence, clinical significance and time course of RV involvement in patients with TTC by echocardiographic follow-up Methods: Over a 9-year period, we observed 76 TTC patients (69 f, 7m, age 70±12). By echocardiography, 15 pts (20%) had RV involvement. Clinical parameters, ECG, echocardiographic and angiographic findings were compared in patients with and without RV involvement. Results: RV wall motion abnormalities involved the apicolateral (n=9), mediolateral (n=4), anterolateral (n=1) and inferior (n=1) segments. Normalization of RV contraction always occurred before normalization of LV function (11±4 vs 33±27 days). In patients with RV involvement, time from symptom onset to hospital admission was shorter (4±5 vs 9±9 hours, p=0.004). The ECG on admission showed a higher heart rate (100±22 vs 86±22 beats per minute, p=0.03), and more patients with RV involvement developed giant negative T waves during follow-up (6/15 vs 10/61, p<0.05). Other ECG parameters were not different in patients with or without RV involvement. Cardiac markers, angiographic ballooning pattern of the LV and end-diastolic LV pressure were comparable in both groups. LV ejection fraction, however, was significantly lower in patients with RV involvement (42±12 vs 53±13%, p=0.005). Overall, more patients with RV involvement developed complications during the acute clinical course (73% vs 36%, p<0.01). There was a higher frequency of ventricular tachycardia (27% vs 5%, p<0.03), acute mitral regurgitation (20% vs 5%, p<0.04) and LV thrombus and/ or stroke (20% vs 5%) in patients with RV involvement, and time to complete normalisation of LV function was longer (32±27 vs 20±13 days, p<0.01). Conclusion: As assessed by echocardiography, RV involvement occurs in 20% of patients with TTC and is associated with a significantly higher rate of complications. Since ventricular tachycardia and thrombus or stroke are frequently observed, prolonged monitoring and anticoagulation is advisable in these patients.

Right Ventricular Involvement in Patients with Fabry’s Disease and the Effect of Enzyme Replacement Therapy

According to echocardiography reports, Fabry cardiomyopathy not only affects the left ventricle (LV) but also the right ventricle (RV). Until now no MRI studies about the effect of enzyme replacement therapy (ERT) on the RV are available. We evaluated the effect of ERT on the RV. In this prospective trial 14 patients with genetically proven Fabry's disease were examined using a 1.5 T MR scanner before ERT and after 13 ± 1 months of ERT. All patients underwent cardiac MR imaging and the RV/LV cardiac morphology and function were analyzed. At baseline examination the values were as follows: RV mass 31 ± 6 g/m (2), end-diastolic volume (EDV) 88 ± 13 ml/m (2), end-systolic volume (ESV) 39 ± 9 ml/m (2), stroke volume (SV) 49 ± 7 ml/m (2) and ejection fraction (EF) 56 ± 5 %. The RV mass and EDV decreased significantly after 13 ± 1 months on ERT (mass 27 ± 7 g/m (2), p < 0.05, EDV 76 ± 24 ml/m (2), p < 0.05), with no significant change of ESV (33 ± 13 ml/m (2)), SV (43 ± 12 ml/m (2)) and EF (57 ± 7 %). The LV mass (102 ± 26 g/m (2) vs. 94 ± 27 g/m (2), p < 0.05), EDV (76 ± 13 ml/m (2) vs. 66 ± 22 ml/m (2), p < 0.05) and ESV (29 ± 9 ml/m (2) vs. 23 ± 9 ml/m (2), p < 0.05) decreased significantly while the EF (64 ± 7 % vs. 66 ± 5 %; p < 0.05) increased significantly. Besides the known beneficial effect on the LV, ERT improves RV mass and EDV.

Right ventricular involvement in patients with coronary artery disease

RV involvement in coronary artery disease (CAD) includes isolated infarction and involvement in left ventricular infarction. Right ventricular involvement with left ventricular infarction has unique clinical signs and symptoms, requires different management, and has worse prognosis than left ventricular infarcts without right ventricular involvement. Although the right ventricle (RV) is geometrically complex, advances in echocardiography, nuclear imaging, computed tomography, and magnetic resonance imaging technologies have helped to optimally visualize its structure and function and to better elucidate its role in CAD. Newer noninvasive imaging modalities to visualize the RV are highlighted and their emerging clinical utilities are emphasized, including three-dimensional echocardiography, tissue Doppler velocity and strain imaging, computed tomography, and MRI. The RV is often involved in CAD. Available imaging modalities demonstrate different aspects of right ventricular involvement, yielding new insights into pathophysiology, clinical care, and management. As imaging technologies widen in their scope, cardiologists will increasingly have the imaging tools to integrate information on right ventricular morphology, hemodynamics, and function, enabling appropriate care for patients with right ventricular involvement in CAD.

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

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). 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. 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. 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.

Tricuspid Annular Velocity Assessed by Doppler Tissue Imaging as a Marker of Right Ventricular Involvement in the Acute and Late Phase after a First ST Elevation Myocardial Infarction

Right ventricular (RV) involvement in patients with ST elevation myocardial infarction (STEMI) is a clinically important problem. The aim of this study was to evaluate the use of tricuspid annular velocity assessed by Doppler tissue imaging (DTI) as a marker of RV involvement in patients with a first STEMI. Seventy-one patients with a first STEMI were examined by echocardiography before discharge and after 6 months. The patients were compared to 31 healthy subjects (HS). The diagnosis of RV infarction was based on the presence of >or= 1 mm ST elevation in the right precordial ECG lead V4R. Tricuspid annular systolic and diastolic velocities using pulsed-wave DTI were recorded at the RV free wall. At day 1, tricuspid annular velocities were significantly reduced in patients with, compared to those without, ST elevation in V4R (11.1 vs. 13.7 cm/sec, 9.4 vs. 13.1 cm/sec and 14.1 vs. 15.9 cm/sec for systolic, early, and late diastolic velocities, respectively; P < 0.01). With a cutoff value for a tricuspid annular systolic velocity of 13 cm/sec, sensitivity and specificity for identifying patients with ST elevation in V4R were 89% and 71%, respectively. After 6 months, both tricuspid annular systolic and diastolic velocities in patients with RV infarction had increased significantly, but only tricuspid annular systolic velocity was still reduced compared to HS (12.3 vs. 14.7 cm/sec; P < 0.01). Tricuspid annular velocities assessed by DTI may be used as a marker of RV involvement in the acute and the late phase after a first STEMI.

Prognostic impact of right ventricular involvement in patients with acute myocardial infarction: Meta-analysis

The objective of this study was to examine the relationship between right ventricular involvement (RVI) in acute myocardial infarction (AMI) and the increase in mortality and morbidity frequently suggested in the last two decades. The authors conducted a systematic review and meta-analysis. This study was conducted at an academic medical center. The authors reviewed PubMed, BioMedCentral, and the Cochrane database and conducted a manual review of article bibliographies. Using a prespecified search strategy, 22 relevant studies involving a total of 7,136 patients with AMI at baseline, of whom 1,963 had RVI (27.5%), were included in a meta-analysis using a random effects model. Pooled relative risks of the impact of RVI on patient mortality and morbidity were calculated. An overall pooled relative risk mortality increase of 2.59 (95% confidence interval, 2.02-3.31) was found (Z = 7.57; p < .00001). RVI in AMI was also associated with a statistically significant increase in all secondary end points assessed, including cardiogenic shock, ventricular arrhythmias, advanced atrioventricular block, and mechanical complications. Our results support the view that early recognition of RVI, namely by means of right electrocardiographic leads in acute myocardial infarction, may have prognostic value. Whether or not this recognition will permit improvement of outcomes through more aggressive percutaneous coronary intervention would need to be tested in future studies.

1145 Prognostic value of right ventricular involvement in patients with systemic lupus erythematosus and subclinical myocardial dysfunction

1145 Prognostic value of right ventricular involvement in patients with systemic lupus erythematosus and subclinical myocardial dysfunction

569 Prognostic value of left and right ventricular involvement in patients with isolated extreme obesity and subclinical myocardial dysfunction

Age, years 58±6 60±10 64±6 0.160 Male, n (%) 7 (47) 9 (60) 9 (60) ... QRS, msec 91±9 143±15* 156±41 ? <0.0001 LV EF, % 63±8 53±8* 33±14 ? <0.0001 LV EDV, ml 85±31 134±37* 192±105 ? ?<0.0001 IVMD, msec 1±12 59±19* 51±19 ? <0.0001 TAPSE, mm 24±2 24±5 20±5 ?? 0.013 Peak Sm (cm/sec) 13±3 13±3 10±2 ?? 0.004 RV area, cm2 14.1±3.9 13.5±4.3 15.8±5.5 0.348 RV LAX, cm 6.9±0.9 7.3±1.5 7.3±1.2 0.600 RV ANN, cm 3.8±1.3 3.4±1.2 3.3±1.0 0.494