Extent of RV Dysfunction and Myocardial Infarction Assessed by CMR Are Independent Outcome Predictors Early After STEMI Treated With Primary Angioplasty

[摘要] OBJECTIVES The aim of this study was to assess the prognostic value of right ventricular (RV) involvement diagnosed by cardiac magnetic resonance (CMR) early after ST-elevation myocardial infarction (STEM I). BACKGROUND CMR allows accurate and reproducible RV assessment. However, there is a paucity of data regarding he prognostic value of RV involvement detected by CMR early after STEMI. METHODS Ninety-nine patients (77 men, mean age 57 +/- 11 years) who underwent CMR 3 to 5 days after STEMI treated with primary angioplasty were followed for 1,150 +/- 337 days for cardiac events (cardiac death, nonfatal myocardial infarction [MI], and hospitalizations due to decompensated heart failure). Cox proportional hazards model was applied in stepwise forward fashion to identify outcome predictors. Event-free survival was estimated by Kaplan-Meier method and compared between groups by the log-rank test. RESULTS Cardiac events occurred in 34 patients (7 cardiac deaths, 8 MIs, 26 hospitalizations). By multivariable analysis, the independent outcome predictors were left ventricular (LV) MI transmurality index (hazard ratio: 1.03 per 1%; 95% confidence interval: 1.01 to 1.04; p = 0.001), RV ejection fraction (RVEF) (hazard ratio: 1.46 per 10% decrease; 95% confidence interval: 1.05 to 2.02; p = 0.03), and RVMI extent (hazard ratio: 1.50 per each infarcted RV segment; 95% confidence interval: 1.11 to 2.01; p = 0.007). Compared with clinical data (global chi-square = 5.2), LV ejection fraction [LVEF] (global chi-square = 11.1), RVEF (global chi-square = 17.1), LVMI transmural extent (global chi-square = 26.0), and RVMI extent (global chi-square = 34.9) improved outcome prediction in sequential Cox model analysis (p < 0.05 for all steps). RVEF stratified risk in patients with LVEF <40% in whom the 4-year event-free survival was 66.7% for RVEF >= 40% and 40.0% for RVEF <40% (p <0.05). CONCLUSIONS The extent of RVMI and RV dysfunction assessed early after STEMI are independent outcome predictors, which provide incremental prognostic value to clinical data, LV systolic function, and infarct burden. Measurement of RVEF may be particularly useful to stratify risk in patients with depressed LV function after STEMI. (J Am Coll Cardiol Img 2010;3:1237-46) (C) 2010 by the American College of Cardiology Foundation

[发布日期] 2010-12-01

[关键词] cardiac magnetic resonance;myocardial infarction;outcome;right ventricle