P417Right ventricular repercussion in patients with acute ST-segment elevation myocardial infarction. Characterization with cardiovascular magnetic resonance.


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Abstract

Objectives: We sought to characterize the right ventricular repercussion in patients with reperfused acute ST-segment elevation myocardial infarction (STEMI) using cardiac magnetic resonance (CMR) and its correlation with the ECG, left ventricle (LV) injury at 6 months follow-up.Methods: We included 38 consecutive patients with a first STEMI and reperfused right proximal coronary artery occlusion, studied with an early CMR (7±3 days after STEMI). We quantified volumes, systolic function, wall motion abnormalities, myocardial edema and necrosis. We carried out a control CMR in 23 patients at 6±1 month follow-up.Results: The mean age was 61±11 years and 79% were male. The mean right ventricular ejection fraction (RVEF) was 57±9% and the RV end-diastolic volume (RVEDV) 67± 17 ml/m2. Half of the patients showed wall motion abnormalities in the RV, 42% edema and 37% late enhancement in at least one segment. In 37% of the patients we observed depressed RVEF (<53%), although only in 4 cases it was moderate and in none severe. ST-segment elevation in right precordial leads was highly specific for detecting necrosis (Sp: 80%) but with low sensitivity (S:63%). There was no correlation between RV parameters and LV systolic disfunction or infarct size. At 6 months follow-up, RVEF (59 ±8%, p=ns) ml/m2 and RVEDV 67±20, p=ns) ml/m2 did not change; a significant decrease in the extent of wall motion abnormalities (1.7±2.1 vs 0.8±1.6 segments, p=0.008) and in the percentage of patients with necrosis were observed.Conclusions: In reperfused inferior STEMI, RV repercussion is common but less extensive than expected. Global systolic function is altered in a minority of cases and there was no correlation between RV parameters and LV systolic disfunction or infarct size. ST segment elevation in right precordial leads represents a specific but not sensitive index to detect RV necrosis. At 6 months follow-up global RV parameters do not worsen and there is an improvement in segmental contractility.

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