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CLINICAL RESEARCH: ACUTE CORONARY SYNDROME

Right Ventricular Dysfunction Assessed by Cardiovascular Magnetic Resonance Imaging Predicts Poor Prognosis Late After Myocardial Infarction

Eric Larose, DVM, MD^_*,1, Peter Ganz, MD^_*, H. Glenn Reynolds, MSc, Sharmila Dorbala, MD, Marcelo F. Di Carli, MD, Kenneth A. Brown, MD and Raymond Y. Kwong, MD, MPH^_*,_*

^_* Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
General Electric Healthcare, Boston, Massachusetts
Cardiology Unit, University of Vermont College of Medicine, Burlington, the Vermont.

Manuscript received May 18, 2006; revised manuscript received October 3, 2006, accepted October 9, 2006.

^_* Reprint requests and correspondence: Dr. Raymond Y. Kwong, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115. (Email: rykwong{at}partners.org).

OBJECTIVES: We sought to determine whether right ventricular (RV) function late after myocardial infarction (MI) impacts long-term prognosis.

BACKGROUND: Right ventricular failure predicts early mortality in patients with acute MI. The prognostic impact of RV function late after MI is not well defined. Accordingly, we determined whether RV dysfunction late after MI influences survival beyond traditional risk predictors, including patient age, left ventricular ejection fraction (LVEF), and infarct size.

METHODS: We studied 147 consecutive patients >30 days after MI (mean age of infarct 6.7 ± 8.2 years) who were referred for contrast-enhanced cardiovascular magnetic resonance imaging. We assessed hazard ratios for death by RV ejection fraction (RVEF). The association of RVEF with mortality adjusted to traditional risk predictors was examined by using multivariable Cox proportional hazards regression models.

RESULTS: A total of 26 deaths occurred during a median follow-up of 17 months (range 6 to 53 months). By univariable analysis, RVEF <40% was strongly associated with mortality (unadjusted hazard ratio 4.02; p = 0.0007). By multivariable analysis that adjusted for patient age, left ventricular (LV) infarct size, and LVEF, RVEF <40% remained a significant independent predictor of mortality (adjusted hazard ratio 2.86; p = 0.03).

CONCLUSIONS: Right ventricular ejection fraction quantified late after MI is an important predictor of prognosis adjusted for patient age, LV infarct size, and LVEF. Accordingly, evaluation of RVEF using cardiovascular magnetic resonance imaging can improve risk-stratification and potentially refine patient management after MI.

Abbreviations and Acronyms   CMR = cardiovascular magnetic resonance imaging   EF = ejection fraction   ESVi = indexed end-systolic volume   HR = hazard ratio   LA = left atrium   LGE = late gadolinium enhancement   LV = left ventricular   LVEF = left ventricular ejection fraction   MI = myocardial infarction   RV = right ventricular   RVEF = right ventricular ejection fraction

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