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Right ventricular infarction: larger enzyme release with posterior than with anterior involvement
H R Andersen1, D Nielsen, E Falk
1Department of Cardiology, Aalborg Sygehus, Denmark.
Insights
The right ventricle releases cardiac enzymes during myocardial infarction, particularly in posterior infarcts. This study found significant right ventricular enzyme contribution to lactate dehydrogenase levels in posterior myocardial infarctions.
Area of Science:
- Cardiology
- Pathology
Background:
- Myocardial infarction (MI) diagnosis relies on cardiac enzyme levels.
- The contribution of the right ventricle to enzyme release during MI is not fully understood.
Purpose of the Study:
- To determine if the right ventricle releases significant cardiac enzymes during myocardial infarction.
- To assess the origin of enzyme release in anterior versus posterior infarcts.
Main Methods:
- A clinicopathologic study of 50 patients with 60 myocardial infarcts.
- Infarct size was measured at autopsy.
- Peak serum lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels were compared with infarct size.
Main Results:
- Anterior and posterior infarcts showed similar anatomic sizes and peak enzyme values.
- Excluding the right ventricle component in posterior infarcts significantly decreased the correlation between infarct size and peak LDH (r=0.84 to r=0.59, P=0.09).
- No significant change in correlation was observed for anterior infarcts (r=0.88).
Conclusions:
- The right ventricle contributes significantly to enzyme release during posterior myocardial infarction.
- Enzyme release during anterior myocardial infarction is primarily from the left ventricle.
Abstract:
To evaluate whether the right ventricle releases significant amount of cardiac enzymes during myocardial infarction, a clinicopathologic study of 50 patients with 60 infarcts was performed. Myocardial infarct size was determined at autopsy and compared with the corresponding peak serum lactate dehydrogenase and aspartate aminotransferase. Anterior and posterior infarcts had similar anatomic size, peak enzyme values, and coefficients of correlation (r = 0.86-0.88 versus r = 0.82-0.84 for lactate dehydrogenase). However, by disregarding the right ventricular infarct component considering the left ventricular infarction only, the coefficient of correlation between infarct size and peak serum lactate dehydrogenase decreased from r = 0.84 to r = 0.59 (P = 0.09), in 14 posterior infarcts while no change was observed in 24 anterior infarcts (r = 0.88). This indicates, that a considerable amount of enzymes released during posterior infarction originated from the right ventricle which was not the case for anterior infarction.