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FOCUS ISSUE: CARDIAC IMAGING: CLINICAL RESEARCH

Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging of Right Ventricular Infarction

Andreas Kumar, MD^_*,, Hassan Abdel-Aty, MBBCh, MSc^_*,, Ilka Kriedemann, Jeanette Schulz-Menger, MD, C. Michael Gross, MD, Rainer Dietz, MD and Matthias G. Friedrich, MD, FESC^_*,,_*

^_* Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
Franz-Volhard-Klinik, Helios Klinikum Berlin, Kardiologie, Charité Universitätsmedizin Campus Berlin-Buch, Humboldt Universität zu Berlin, Berlin, Germany

Manuscript received March 2, 2006; revised manuscript received April 18, 2006, accepted May 22, 2006.

^_* Reprint requests and correspondence: Dr. Matthias G. Friedrich, Department of Cardiac Sciences, University of Calgary, Stephenson Cardiovascular MR Centre, Foothills Medical Centre, Suite 0700-SSB, 1403–29th Street NW, Calgary, Alberta, T2N 2T9, Canada (Email: matthias.friedrich{at}ucalgary.ca).

Data of this study were the subject of an oral presentation at the 2005 American College of Cardiology Annual Meeting in Orlando, Florida.

OBJECTIVES: We assessed the role of late enhancement cardiovascular magnetic resonance imaging (LE-CMR) for the diagnosis of right ventricular infarction (RVI).

BACKGROUND: Right ventricular infarction occurs in about one-half of patients with inferior myocardial infarction (MI). It is associated with an unfavorable prognosis, but established methods often lack the diagnostic accuracy to detect it. Late enhancement cardiovascular magnetic resonance imaging accurately detects left ventricular MI.

METHODS: Thirty-seven patients with acute inferior MI were included. To test for RVI, they prospectively underwent a physical examination, an electrocardiogram (ECG) for ST-segment elevation in the V₄r right precordial lead, and an echocardiogram. After coronary reperfusion, LE-CMR was performed for assessing presence and extent of late enhancement in the right ventricular (RV) wall. The LE-CMR data were compared with the other results; interobserver variability was assessed. The LE-CMR was repeated after 13 months.

RESULTS: Late enhancement cardiovascular magnetic resonance imaging detected RVI in 21 of 37 (57%) patients with acute inferior MI. Interobserver variability was very good (kappa 0.83); physical exam was positive for RVI in 7 of 37 (19%) patients, V₄r ECG in 13 of 37 (35%) patients, and echocardiogram in 6 of 37 (16%) patients. The LE-CMR findings for RVI showed only mild agreement with findings for RVI on physical exam (kappa 0.30), V₄r ECG (kappa 0.38), and echocardiography (kappa 0.32). Irreversible injury of the RV persisted at 13 months (kappa 0.85).

CONCLUSIONS: In patients with acute inferior MI, RVI is more frequently detected by LE-CMR than by current standard diagnostic techniques. Further CMR studies might allow for analyzing its clinical and prognostic relevance.

Abbreviations and Acronyms   CMR = cardiovascular magnetic resonance imaging   ECG = electrocardiogram   LE-CMR = late enhancement cardiovascular magnetic resonance imaging   LV = left ventricle/ventricular   MI = myocardial infarction   RCA = right coronary artery   RV = right ventricle/ventricular   RVI = right ventricular infarction

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