CLINICAL STUDY: MYOCARDIAL INFARCTION
Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction
Leonardo A. M. Zornoff, MD, PhD*,
Hicham Skali, MD*,
Marc A. Pfeffer, MD, PhD, FACC*,
Martin St. John Sutton, MD, FACC ,
Jean L. Rouleau, MD, FACC ,
Gervasio A. Lamas, MD, FACC ,
Ted Plappert, CVT,
Jacques R. Rouleau, MD||,
Lemuel A. Moyé, MD, PhD¶,
Sandra J. Lewis, MDFACC#,
Eugene Braunwald, MD, FACC*,
Scott D. Solomon, MD, FACC*,* SAVE Investigators
* Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Cardiovascular Division, University Health Network and Mt. Sinai Hospital, Toronto, Ontario, Canada
Cardiovascular Division, Mt. Sinai Medical Center, Miami Beach, Florida, USA
|| Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
¶ School of Public Health, University of Texas, Houston, Texas, USA
# Portland Cardiovascular Institute, Portland, Oregon, USA
Manuscript received October 29, 2001;
revised manuscript received February 11, 2002,
accepted February 14, 2002.
* Reprint requests and correspondence: Dr. Scott D. Solomon, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA 02115.
ssolomon{at}rics.bwh.harvard.edu
OBJECTIVES: The aim of this study was to determine the prognostic value of right ventricular (RV) function in patients after a myocardial infarction (MI).
BACKGROUND: Right ventricular function has been shown to predict exercise capacity, autonomic imbalance and survival in patients with advanced heart failure (HF).
METHODS: Two-dimensional echocardiograms were obtained in 416 patients with left ventricular (LV) dysfunction (ejection fraction [LVEF]  40%) from the Survival And Ventricular Enlargement (SAVE) echocardiographic substudy (mean 11.1 ± 3.2 days post infarction). Right ventricular function from the apical four-chamber view, assessed as the percent change in the cavity area from end diastole to end systole (fractional area change [FAC]), was related to clinical outcome.
RESULTS: Right ventricular function correlated only weakly with the LVEF (r = 0.12, p = 0.013). On univariate analyses, the RV FAC was a predictor of mortality, cardiovascular mortality and HF (p < 0.0001 for all) but not recurrent MI. After adjusting for age, gender, diabetes mellitus, hypertension, previous MI, LVEF, infarct size, cigarette smoking and treatment assignment, RV function remained an independent predictor of total mortality, cardiovascular mortality and HF. Each 5% decrease in the RV FAC was associated with a 16% increased odds of cardiovascular mortality (95% confidence interval 4.3% to 29.2%; p = 0.006).
CONCLUSIONS: Right ventricular function is an independent predictor of death and the development of HF in patients with LV dysfunction after MI.
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Abbreviations and Acronyms
| | FAC | | fractional area change | | HF | | heart failure | | LV | | left ventricle or ventricular | | LVEF | | ejection fraction | | MI | | myocardial infarction | | RV | | right ventricle or ventricular | | SAVE | | Survival And Ventricular Enlargement trial |
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