Marco Francone MD, Presenter: Nothing to Disclose

Pier Giorgio Masci, Abstract Co-Author: Nothing to Disclose

Iacopo Carbone MD, Abstract Co-Author: Nothing to Disclose

Javier Ganame MD, PhD, Abstract Co-Author: Nothing to Disclose

Massimo Lombardi MD, Abstract Co-Author: Nothing to Disclose

Jan Bogaert MD, Abstract Co-Author: Nothing to Disclose

Experimental data show that the right ventricle is more resistant to ischemia than the left ventricle. To date, limited data are available in humans due to the difficulty to discriminate reversible from irreversible ischemic damage. We sought to characterize right ventricular (RV) ischemic injury in patients with reperfused myocardial infarction (MI) using cardiovascular magnetic resonance (CMR).

In 3 tertiary centers, 242 consecutive reperfused acute ST-segment elevation MI patients were studied with CMR at 1-week and 4-month after MI using a standard acquisition protocol with 1.5 CMR scanners. T2-weighted and post-contrast CMR were used to depict myocardial edema and delayed enhancement, respectively.

Early post-infarction, RV myocardial edema was common (51% of patients), often associated with RV delayed enhancement (31% of patients). Remarkably, RV myocardial edema and RV delayed enhancement were observed in 33% and 12% of anterior LV infarcts, respectively. Baseline regional and global RV functions were inversely related to the presence and extent of RV myocardial edema and RV delayed enhancement. At follow-up, a significant decrease in frequency (25/242 patients,10%) and extent of RV delayed enhancement was observed (P<0.001). At multivariate analysis, presence of baseline RV myocardial edema was the only predictor of RV global function improvement during follow-up (β coefficient=0.228, P=0.006).

Early post-infarction RV ischemic injury is common and characterized by presence of myocardial edema, delayed enhancement and functional abnormalities. RV injury is not limited to inferior infarcts, but is commonly observed in anterior infarcts as well. CMR findings suggest reversibility of acute RV dysfunction with limited permanent myocardial damage at 4-month follow-up.

Temporary RV dysfunction related to RV ischemic involvement frequently occurs early post-infarction; RV DE may be an epiphenomenon of extensive edema, and not necessarily be synonymous of necrosis.

Francone, M, Masci, P, Carbone, I, Ganame, J, Lombardi, M, Bogaert, J, Right Ventricular Ischemic Injury in Patients with Acute ST-segment Elevation Myocardial Infarction Characterization with Cardiovascular Magnetic Resonance  .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9006125.html