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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2008; 51:1616, doi:10.1016/j.jacc.2007.12.042
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Right Ventricular Asynergy as a Prognosticator

Sujeeth R. Punnam, MD* and Abhijeet Dhoble, MD

* Division of Cardiology, A-205 Clinical Center, Michigan State University, East Lansing, Michigan 48823 (Email: punnam{at}msu.edu).

Bangalore et al. (1) looked at the prognostic value of right ventricular (RV) asynergy during routine stress echocardiography in patients with known or suspected coronary artery disease and concluded that an abnormal RV can further stratify risk and prognosticate the results. We have 2 concerns with the study. 1) Rest- or stress-induced RV dysfunction and enlargement could also be from primary or secondary pulmonary hypertension apart from coronary artery disease. The investigators did not give any information on chronic obstructive pulmonary disease prevalence in this cohort, which could be a confounding variable and could have an impact on survival. 2) Regional stress-induced RV dysfunction (McConnell sign) (2) is also seen in acute pulmonary embolism apart from RV infarction. Ramanath et al. (3) reported a case of pulmonary embolism that was detected in a patient with a normal resting echocardiogram but a markedly abnormal post-treadmill exercise echocardiogram revealing RV dilatation from a pulmonary embolism. Again, Bangalore et al. (1) did not comment on any risk factors for pulmonary embolism in these patients that could have an impact on survival.


   References
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 References
 

  1. Bangalore S, Yao S, Chaudhry FA. Role of right ventricular wall motion abnormalities in risk stratification and prognosis of patients referred for stress echocardiography J Am Coll Cardiol 2007;50:1981-1989.[Abstract/Free Full Text]
  2. Casazza F, Bongarzoni A, Capozi A, Agostoni O. Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction Eur J Echocardiogr 2005;6:11-14.[Abstract/Free Full Text]
  3. Ramanath VS, Lacomis JM, Katz WE. Diagnosis of pulmonary embolism by acute right heart morphologic and hemodynamic changes observed during exercise stress echocardiography J Am Soc Echocardiogr 2004;17:1005-1008.[CrossRef][ISI][Medline]

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Sripal Bangalore and Farooq A. Chaudhry
J. Am. Coll. Cardiol. 2008 51: 1616-1617. [Full Text] [PDF]




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