Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

Abstract

INTRODUCTIONApproximately 50% of inferior wall infarction cases are associated with right ventricular (RV) infarction. 1,2 The incidence of left ventricular (LV) infarction in association with RV infarction ranges from 14% to 84%. [3][4][5] Infarction of the right ventricle alone, on the other hand, is reported in less than 3% of myocardium infarction (MI) cases. 6,7 From an epidemiological point of view, these differences make it diffi cult to accurately evaluate the impact of RV infarction in populations studied.It is the right coronary artery that is most frequently involved, obstructed in its proximal third, thus resulting in dysfunction of the free walls of the right ventricle and the walls of the inferior left ventricle. 8 Although the performance of the right ventricle spontaneously improves even in the absence of coronary reperfusion, its recovery may be slow and may be associated with high rates of atrioventricular conduction, hemodynamic instability and hospital mortality. 9-11 Reperfusion optimizes the recuperation of the right ventricle and improves patients' clinical evolution. 8 The gold standard for the diagnosing of RV infarction is hemodynamic evaluation or an autopsy. It is known that this diagnosis may be made by clinical evaluation, 12,13 electrocardiogram (EKG), hemodynamic evaluation, studies using radioisotopes such as technetium 99m ( 99m Tc) pyrophosphate, and right nuclear ventriculography.EKG using the right V 3 and V 4 (V 3 R and V 4 R) derivations is a simple method presenting good sensitivity and specifi city. 14-17 Identifi cation of right ventricular abnormality, shown by elevation of the ST segment in the right derivations, especially V 4 R, is an important predictor of hospital complications and mortality. 17 It is now known that thrombolytic therapy in patients presenting infarction in

Factors associated with long-term prognosis in patients with myocardial infarction of the right ventricle, evaluated by the kaplane-meyer method

“…За даними медичної статистики ураження ПШ діагностують в 14-84 % випадків заднього ІМ ЛШ та в 10-13 % випадків ІМ ЛШ передньої локалізації [1,2]. Така висока варіабельність показників є наслідком пев-них труднощів діагностики та недостатньої насто-роженості щодо розвитку ІМ ПШ, що, в свою чергу, ускладнює як епідеміологічну оцінку, так визначення впливу ІМ ПШ на прогноз та якість життя.…”

“…Клінічні ускладнення ІМ ПШ варіюють в широких межах від гемодинамічного компромісу до тяжкої гіпотензії і кардіогенного шоку в залежності від ступеня ішемії [2,3]. Це зумовлює відсутність єдиної думки щодо самостійного впливу ІМ ПШ на підвищення ризику фатальних ускладнень та смерті, що спонукає до подальших досліджень в цьому напрямку.…”

The challenges in the management of right ventricular infarction

“…22 However, although the number of patients with RV infarction is small, these patients seem to have a higher risk of in-hospital mortality in the mechanical reperfusion era than during the fibrinolytic era. Figure 2 shows the changes in the in-hospital mortality rate and relative risk of RV infarction for in-hospital mortality between the fibrinolytic and mechanical reperfusion era; 8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] An increase in the relative risk of RV infarction from 2.29 (95% CI 1.67-3.14) to 2.98 (95% CI 1.41-6.31) also occurred during this period. The precise explanation for the paradox remains unknown.…”

“…These data were derived from previously published meta-analyses, 21 which included many prospective or retrospective studies, assessing the impact of RV infarction in patients with acute MI up to June 2007, 8,[23][24][25][26][27][28][29][30][33][34][35][36] and two additional observational studies that met the same inclusion criteria up to June 2012. 31,32 of concomitant LV involvement, this study indicated that the mean optimal PWP, which corresponded to the maximum LV stroke work index in each patient, was 16 mmHg.…”

Alteration in the global and regional myocardial strain patterns in patients with inferior ST‐elevation myocardial infarction prior to and after percutaneous coronary intervention

“…Right ventricle (RV) function is an important prognostic factor for clinical outcomes in patients with acute MI of LV. Moreover, RV involvement occurs in a percentage of patients suffering an inferior wall MI and increases in‐hospital death rates [7,8]. The objective of the present study was to quantify regional or global deformation of LV and RV in patients with inferior wall MI prior to and after percutaneous coronary intervention (PCI).…”