Author + information
- Received March 2, 2006
- Revision received April 18, 2006
- Accepted May 22, 2006
- Published online November 21, 2006.
- Andreas Kumar, MD⁎,†,1,
- Hassan Abdel-Aty, MBBCh, MSc⁎,†,1,
- Ilka Kriedemann†,
- Jeanette Schulz-Menger, MD†,
- C. Michael Gross, MD†,
- Rainer Dietz, MD† and
- Matthias G. Friedrich, MD, FESC⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Matthias G. Friedrich, Department of Cardiac Sciences, University of Calgary, Stephenson Cardiovascular MR Centre, Foothills Medical Centre, Suite 0700-SSB, 1403–29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
Objectives We assessed the role of late enhancement cardiovascular magnetic resonance imaging (LE-CMR) for the diagnosis of right ventricular infarction (RVI).
Background Right ventricular infarction occurs in about one-half of patients with inferior myocardial infarction (MI). It is associated with an unfavorable prognosis, but established methods often lack the diagnostic accuracy to detect it. Late enhancement cardiovascular magnetic resonance imaging accurately detects left ventricular MI.
Methods Thirty-seven patients with acute inferior MI were included. To test for RVI, they prospectively underwent a physical examination, an electrocardiogram (ECG) for ST-segment elevation in the V4r right precordial lead, and an echocardiogram. After coronary reperfusion, LE-CMR was performed for assessing presence and extent of late enhancement in the right ventricular (RV) wall. The LE-CMR data were compared with the other results; interobserver variability was assessed. The LE-CMR was repeated after 13 months.
Results Late enhancement cardiovascular magnetic resonance imaging detected RVI in 21 of 37 (57%) patients with acute inferior MI. Interobserver variability was very good (kappa 0.83); physical exam was positive for RVI in 7 of 37 (19%) patients, V4r ECG in 13 of 37 (35%) patients, and echocardiogram in 6 of 37 (16%) patients. The LE-CMR findings for RVI showed only mild agreement with findings for RVI on physical exam (kappa 0.30), V4r ECG (kappa 0.38), and echocardiography (kappa 0.32). Irreversible injury of the RV persisted at 13 months (kappa 0.85).
Conclusions In patients with acute inferior MI, RVI is more frequently detected by LE-CMR than by current standard diagnostic techniques. Further CMR studies might allow for analyzing its clinical and prognostic relevance.
↵1 Drs. Kumar and Abdel-Aty are Canadian Institute of Health Research Strategic Training Fellows in TORCH (Tomorrow’s Research Cardiovascular Health Professionals) at the University of Calgary; both are also supported by a non-restricted research grant from Siemens Medical Solutions, Erlangen, Germany.
Data of this study were the subject of an oral presentation at the 2005 American College of Cardiology Annual Meeting in Orlando, Florida.
- Received March 2, 2006.
- Revision received April 18, 2006.
- Accepted May 22, 2006.
- American College of Cardiology Foundation