The Incidence and Impact of Permanent Right Ventricular Infarction on Left Ventricular Infarct Size in Patients With...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Myocardial Infarction

Background:

• Right ventricle (RV) function is increasingly recognized for its prognostic importance in various cardiovascular conditions.
• Inferior ST-segment elevation myocardial infarction (STEMI) often involves the right coronary artery (RCA), potentially leading to RV infarction.

Purpose of the Study:

• To determine the incidence and impact of permanent RV infarction in patients with inferior STEMI and culprit RCA lesions.
• To assess the relationship between permanent RV infarction and subsequent left ventricular (LV) function and infarct size.

Main Methods:

• A substudy of the DANAMI-3 trial included 291 patients with inferior STEMI and RCA culprit lesions.
• Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) was performed at day 1 and 3 months post-primary percutaneous coronary intervention.
• Permanent RV infarction was defined by LGE in the RV free wall at 3-month follow-up.

Main Results:

• Permanent RV infarction was identified in 20% of patients.
• Patients with RV infarction showed lower RV ejection fraction (EF) (47% vs. 50%) and LV EF (56% vs. 60%) at follow-up.
• Permanent RV infarction independently predicted larger final LV infarct size (16% vs. 10%) and was associated with increased microvascular obstruction (67% vs. 39%).

Conclusions:

• Permanent RV infarction is a significant finding in 20% of inferior STEMI patients with RCA lesions.
• RV infarction independently predicts final LV infarct size but does not appear to predict overall LV function.
• CMR with LGE is crucial for detecting and quantifying RV infarction and its impact on myocardial damage.