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Predictors of right ventricular dysfunction in patients with coronary artery disease and reduced left ventricular
Luigi La Vecchia1, Gian Luca Spadaro, Mariemma Paccanaro
1Department of Cardiology, S Bortolo Hospital, Vicenza, Italy. lavecchia.cardiovi@libero.it
Insights
Right ventricular dysfunction occurs in less than 20% of patients with coronary artery disease and reduced left ventricular function. Pulmonary hypertension, not coronary artery disease, is the main predictor of this dysfunction.
Area of Science:
- Cardiology
- Cardiovascular Research
- Internal Medicine
Background:
- Right ventricular (RV) dysfunction in patients with coronary artery disease (CAD) and reduced left ventricular (LV) function is not well understood.
- Investigating the frequency and determinants of RV dysfunction in this population is crucial for clinical management.
Purpose of the Study:
- To determine the prevalence of RV dysfunction in patients with CAD and reduced LV function.
- To identify factors associated with RV dysfunction in this patient group.
Main Methods:
- Eighty patients with LV ejection fraction < 45% and obstructive CAD underwent invasive evaluation, including cardiac catheterization and RV/LV angiography.
- RV dysfunction was defined as an RV ejection fraction < 35%.
Main Results:
- RV dysfunction was present in 18% of patients.
- Occlusion of the proximal right coronary artery was associated with lower RV ejection fraction.
- Pulmonary hypertension was the only independent predictor of RV dysfunction (P < 0.001).
Conclusions:
- RV dysfunction is present in less than 20% of patients with chronic ischemic LV dysfunction.
- While proximal right coronary artery occlusion is linked to reduced RV ejection fraction, pulmonary hypertension is the primary determinant of RV dysfunction in this cohort.
Background:
The frequency and determinants of right ventricular (RV) dysfunction in patients with coronary artery disease (CAD) and reduced left ventricular (LV) function have not been thoroughly investigated.
Methods:
The study population consists of 80 consecutive patients, invasively evaluated at our centre. Entry criteria were: LV ejection fraction < 45%; angiographic evidence of obstructive CAD; disease history of more than 3 months' duration. Exclusion criteria were: recent myocardial infarction and unstable angina. All patients underwent cardiac catheterization with coronary, LV and RV angiography. RV dysfunction was defined as a RV ejection fraction < 35%, which corresponds to the mean-three standard deviations of controls.
Results:
Sixty-five patients (81%) had multi-vessel disease and 57 (71%) had a previous myocardial infarction. Mean LV ejection fraction was 31 +/- 8%. Mean RV ejection fraction was 46 +/- 11%. Right ventricular dysfunction was present in 14 patients (18%). An occluded proximal right coronary artery was associated with significantly lower RV ejection fraction (38 +/- 12% versus 47 +/- 10%; P = 0.009) but not LV ejection fraction (30 +/- 8% versus 32 +/- 9%; P = 0.444). However, at multivariate analysis, only pulmonary hypertension was an independent significant predictor of RV dysfunction (P < 0.001; OR: 1.13; CI: 1.06 -1.22).
Conclusion:
Right ventricular dysfunction in patients with chronic ischaemic LV dysfunction is detected in less than 20% of cases. Proximal right coronary artery occlusion is associated with a reduced RV ejection fraction. However, the role of right coronary artery disease is overwhelmed by the haemodynamic burden of pulmonary hypertension, which represents the only independent predictor of RV dysfunction in our population.