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CLINICAL RESEARCH: CARDIAC IMAGING

Role of Right Ventricular Wall Motion Abnormalities in Risk Stratification and Prognosis of Patients Referred for Stress Echocardiography

Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital and Columbia University, New York, New York.

Manuscript received April 20, 2007; revised manuscript received July 6, 2007, accepted July 15, 2007.

^_* Reprint requests and correspondence: Dr. Farooq A. Chaudhry, Director of Echocardiography, Division of Cardiology, Columbia University College of Physicians and Surgeons, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, New York 10025. (Email: fchaudhr{at}chpnet.org).

Presented in part at the 2005 Annual Scientific Session of the American Heart Association, November 16, 2005, New Orleans, Louisiana.

Objectives: The purpose of this study was to evaluate the prognostic value of assessing right ventricular (RV) wall motion abnormalities during stress echocardiography (SE).

Background: The results of SE are usually interpreted based on wall motion abnormalities of the left ventricle (LV). There is increasing recognition of the prognostic importance of RV. However, RV is still a "forgotten" chamber during routine SE.

Methods: We evaluated 2,703 patients referred for SE. The LV was evaluated on a 16-segment model 5-point scale and the RV was evaluated on a 3-segment model 5-point scale for wall motion abnormalities. An abnormal RV or LV was defined as one with new (ischemic) or fixed (infarction) wall motion abnormalities. Follow-up (2.7 ± 1.0 years) for confirmed myocardial infarction and cardiac death (n = 122) were obtained.

Results: An abnormal RV was seen in 112 patients (4%). In the presence of an abnormal LV, patients with abnormal RV had a worse prognosis than those with normal RV. Abnormal RV was a significant predictor of events (adjusted hazard ratio 2.69, 95% confidence interval 1.22 to 5.92; p = 0.014) independent of LV ischemia and ejection fraction. A forward conditional Cox model showed that peak RV wall motion score index provided incremental prognostic value over rest and conventional SE variables (global chi-square increased from 141.4 to 161.8 to 197.0; p < 0.0001 and p = 0.006, respectively).

Conclusions: In patients referred for SE, RV wall motion analysis provides prognostic value independent of LV ischemia and ejection fraction and provides incremental value over rest and conventional SE variables. Right ventricular wall motion analysis should be routinely performed in patients referred for SE for effective risk stratification.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiogram/electrocardiography   LV = left ventricular/ventricle   MI = myocardial infarction   MPHR = maximum predicted heart rate   RV = right ventricular/ventricle   WMSI = wall motion score index

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