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[Right ventricular function in patients with chronic right ventricular infarction]
H Koito1, T Kurimoto, T Sugiura
1Second Department of Internal Medicine, Kansai Medical University, Moriguchi.
Insights
Patients with chronic right ventricular infarction, particularly those in Forrester group III, exhibit significantly impaired right ventricular ejection fraction (RVEF) and increased right ventricular end-diastolic volume index (RVEDVI). This indicates severe right ventricular dysfunction and wall motion abnormalities.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Context:
- Assessing right ventricular (RV) function is crucial in managing patients post-myocardial infarction.
- Chronic RV infarction can lead to persistent hemodynamic compromise.
- The Forrester classification stratifies patients based on acute hemodynamic status.
Purpose:
- To evaluate right ventricular function in patients with chronic right ventricular infarction.
- To correlate hemodynamic data with objective measures of RV function.
- To identify specific patterns of RV dysfunction and wall motion abnormalities.
Summary:
- Tc-99m angiocardiography was performed in 64 patients with chronic right ventricular infarction.
- Patients were grouped based on acute hemodynamic data (Forrester classification).
- Group III patients (n=8), characterized by elevated right atrial pressure, showed significantly lower right ventricular ejection fraction (RVEF) (25 ± 3%) and higher right ventricular end-diastolic volume index (RVEDVI) (150 ± 25 ml/m²) compared to other groups. Right ventricular regional ejection fraction images (RVREFI) revealed inferior and/or septal wall motion abnormalities in Group III. Coronary angiography in six Group III patients identified proximal right coronary artery lesions.
Impact:
- Findings highlight severe RV dysfunction in Forrester group III patients with chronic RV infarction.
- Demonstrates the utility of Tc-99m angiocardiography in quantifying RV function and regional wall motion.
- Correlates hemodynamic severity with imaging findings and coronary artery disease.
Abstract:
To assess right ventricular function in patients with chronic right ventricular infarction, Tc-99m angiocardiography was performed in 64 patients one to three months after the onset of myocardial infarction. These patients were categorized into four groups according to their hemodynamic data in the acute stage using the Forrester classification: 39 patients in group I, 15 in group II, eight in group III and two in group IV. Mean right atrial pressure was nearly equal to or greater than diastolic pulmonary arterial pressure in all patients in group III. We calculated right ventricular ejection fraction (RVEF) and the right ventricular end-diastolic volume index (RVEDVI) as the parameter of right ventricular function, and assessed right ventricular wall motion using the right ventricular regional ejection fraction images (RVREFI). 1. RVEF in group III (25 +/- 3%) was significantly lower than those in groups I, II and IV (44 +/- 6%, 45 +/- 7% and 37 +/- 4%, respectively), and RVEF of all patients in group III was less than 30%. 2. RVEDVI in group III (150 +/- 25 ml/m2) was significantly greater than those in groups I, II and IV (74 +/- 20 ml/m2, 59 +/- 14 ml/m2 and 91 +/- 36 ml/m2, respectively). 3. RVREFI in group III decreased at the inferior and/or septal regions of the right ventricle, indicating wall motion abnormalities at the corresponding sites. 4. Six patients in group III were examined by coronary angiography and all had definite lesions in the proximal portion of the right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)