Prognostic significance of right ventricular ejection fraction for persistent complex ventricular arrhythmias and/or sudden cardiac death after first myocardial infarction: Relation to infarct location, size and left ventricular function

Pfisterer, Matthias; Emmenegger, H; Solèr, M.; Burkart, F

doi:10.1093/oxfordjournals.eurheartj.a062066

Cited by 51 publications

(23 citation statements)

References 28 publications

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“…However, the increase of RVEDV from baseline to 12 weeks remained significantly greater in AMI patients with SDB versus patients without SDB after accounting for LVESV, a marker of LV function. This is reinforced by the fact that, in accordance with previous studies [20,21], ZORNOFF et al…”

Section: Discussionsupporting

confidence: 83%

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

et al. 2014

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Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3-5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea-hypopnoea index of ≥15 events·h −1 . 12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27) versus those without (n=25) (mean±SD 14±23% versus 0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea-hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013-0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm 2 versus 1.0±2.4 cm 2 , p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI. @ERSpublications Sleep disordered breathing may predispose to enlargement of the right heart after acute myocardial infarction http://ow.ly/Cc6vv

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Section: Discussionsupporting

confidence: 83%

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

et al. 2014

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“…68,69 Dysfunkce PK navíc korelovala se zvýšenou indukovatelností KT při EPS. 70 I když v současnosti nejsou k dispozici žádné důkazy podporující případnou úlohu časného vyšetření PK, které by pomohlo při rozhodování o případné implantaci ICD, dokládají uvedené nálezy skutečnost, že samotná EFLK není jako nástroj stratifi kace rizika v prevenci NSS dostačující.…”

Section: Metody Stratifi Kace Rizika V čAsné Primární Prevenci Nssunclassified

“…68,69 In addition, RV dysfunction has been correlated with increased inducibility of VT at EPS. 70 Although there is no current evidence to support the role of early RV assessment to guide ICD implantation, these findings highlight the inadequacy of LVEF alone as a risk stratification tool for the prevention of SCD. …”

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confidence: 96%

Sudden Cardiac Death Early After Myocardial Infarction

2014

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The issue of SCD primary prevention early after MI remains unresolved. The focus is now firmly centered on the elucidation of risk stratification tests that effectively select patients at high risk of SCD who benefit from early ICD implantation. Zaman and Kovoor Primary Prevention of SCD Early After MI 2429A summary of major risk stratification tests currently used to identify patients at high risk of SCD is given in Table 2. LV DysfunctionImpaired LVEF, one of the most powerful predictors of survival, 64 has been shown to identify patients who derive a mortality benefit from an ICD when implanted predominantly in the remote period after MI. 16,65 However, there are major concerns with the use of LVEF alone as a risk stratifier to guide ICD implantation. One such concern is the low specificity of LVEF for selecting patients who experience arrhythmic versus nonarrhythmic death. In the MADIT II trial, the use of LVEF ≤30% alone to stratify patients for an ICD resulted in relatively small absolute improvement in mortality with low therapeutic efficiency (15-17 defibrillators per life saved). 66 Another concern is the sensitivity of LVEF, given that a large proportion of SCDs still occur in patients with preserved LV function. VALIANT demonstrated that, although the risk of SCD is greatest in patients with severe dysfunction (LVEF ≤30%), almost half of all sudden deaths occur in patients with a higher ejection fraction (LVEF, 31%-40%). 5 The use of LVEF as a risk stratification tool has been tested in the early post-MI stage in the DINAMIT and IRIS trials, which selected patients with LVEF ≤35% and ≤40%, respectively, and failed to show a benefit of early ICD implantation. 12,17 The major limitation with the use of an early LVEF cutoff is the phenomenon of myocardial stunning with variable and unpredictable recovery of LV function after MI. This is especially relevant in the contemporary era of primary PCI for STEMI. Of STEMI patients with LVEF ≤40% at day 3, 24% will improve to have an LVEF >40% at 6 months with a mean 6% relative improvement. 67 Hence, although LV function will invariably be incorporated into risk stratification models for the prevention of SCD, it is clear that other tests are required to adequately select high-risk patients early after MI. RV DysfunctionAlthough impaired LV function has been studied extensively as a predictor of mortality and arrhythmic death, RV dysfunction has been largely overlooked. We know from the VALIANT study that almost 50% of arrhythmic deaths occur in patients with a preserved LVEF.5 RV involvement in inferior MI has been shown to be a predictor of morbidity and mortality, with a higher rate of serious arrhythmias in patients with inferior MI and RV dysfunction. 68,69 In addition, RV dysfunction has been correlated with increased inducibility of VT at EPS. 70 Although there is no current evidence to support the role of early RV assessment to guide ICD implantation, these findings highlight the inadequacy of LVEF alone as a risk stratification tool for the prevention...

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“…The prognosis after acute myocardial in farction (AMI) depends primarily upon left ventricular function [1], This statement seems to apply also to right ventricular in farction [2], Several additional prognostic factors have also been recognized [3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…However, little interest has been paid to the prognostic implications of a postinfarctual right ventricular dysfunction [14,15]. De pressed right ventricular ejection fraction (RVEF) has been reported to be an indepen dent risk factor for death after first AMI [14]; however, reliability of this result is affected by the very low rate of cardiac mor tality [14], A larger-scale study has shown that 1-year survival after AMI is directly related to the left ventricular ejection frac tion (LVEF) and unaffected by RVEF [ 15].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Aneurysm: A New Prognostic Indicator after a First Acute Myocardial Infarction

et al. 1991

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The prognostic implication of a right ventricular aneurysm after a first acute myocardial infarction (AMI) was assessed on a series of 137 AMI patients 12 of whom had a right ventricular aneurysm detected at radionuclide angiocardiography. The follow-up lasted 36 months. Mortality was 50 and 18.4% in patients with and without right ventricular aneurysm, respectively (p < 0.02). Groups did not differ in age, male-to-female ratio, AMI site, left ventricular ejection fraction (LVEF), peak filling rate (PFR), left ventricular size. A multivariate logistic analysis showed that only three out of ten clinical and functional variables qualified to be independent predictors of death: right ventriuclar aneurysm (odd ratio = 2.48, confidence limits = 1.21–4.98), LVEF < 52% (odd ratio = 1.91, confidence limits = 1.03–3.48), abnormal terminal P wave forces (odd ratio = 1.72, confidence limits = 1.07–2.75). The analysis of single case histories did not provide a clue to clarify the reasons accounting for the negative prognostic implication of a right ventricular aneurysm. In conclusion, a significant positive relationship between right ventricular aneurysm and mortality after AMI has been demonstrated; further study is needed to clarify the relevant mechanisms.

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Prognostic significance of right ventricular ejection fraction for persistent complex ventricular arrhythmias and/or sudden cardiac death after first myocardial infarction: Relation to infarct location, size and left ventricular function

Cited by 51 publications

References 28 publications

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

Sudden Cardiac Death Early After Myocardial Infarction

Right Ventricular Aneurysm: A New Prognostic Indicator after a First Acute Myocardial Infarction

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