Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular Infarction

Abstract

In patients with right ventricular infarction, complete reperfusion of the right coronary artery by angioplasty results in the dramatic recovery of right ventricular performance and an excellent clinical outcome. In contrast, unsuccessful reperfusion is associated with impaired recovery of right ventricular function, persistent hemodynamic compromise, and a high mortality rate.

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

“…These studies have also provided information about more effective treatment, with the intention of providing better prognosis for these patients. 8,[21][22][23][24] The present study has demonstrated that 21% of the patients with LV myocardial infarction presented this in association with RV infarction. This is in accordance with the data in the literature, with reported percentages ranging from 14% to 84%.…”

“…Considering similar data, Bowers et al 8 suggested that successful reperfusion by means of primary angioplasty could achieve dramatic improvements in RV performance and improved clinical outcomes among patients with RV myocardial involvement. Furthermore, Mehta et al 29 observed that the presence of RV myocardial involvement itself, rather than the extensive LV infarction, is related to increased risk of death, shock and arrhythmia.…”

“…17 It is now known that thrombolytic therapy in patients presenting infarction in the inferior wall is benefi cial for reducing infarct magnitude and mortality. 8 Patients with inferior myocardial infarction who have RV myocardial involvement appear to have a worse prognosis than those who do not have RV involvement. These patients appear to be at increased risk of severe complications, such as left ventricular failure, cardiogenic shock and serious ventricular arrhythmia, and even death.…”

“…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][10][11] Reperfusion optimizes the recuperation of the right ventricle and improves patients' clinical evolution.…”

“…[9][10][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.…”