Author + information
- Received May 18, 2006
- Revision received October 3, 2006
- Accepted October 9, 2006
- Published online February 27, 2007.
- Eric Larose, DVM, MD⁎,1,
- Peter Ganz, MD⁎,
- H. Glenn Reynolds, MSc‡,
- Sharmila Dorbala, MD†,
- Marcelo F. Di Carli, MD†,
- Kenneth A. Brown, MD§ and
- Raymond Y. Kwong, MD, MPH⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Raymond Y. Kwong, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
Objectives We sought to determine whether right ventricular (RV) function late after myocardial infarction (MI) impacts long-term prognosis.
Background Right ventricular failure predicts early mortality in patients with acute MI. The prognostic impact of RV function late after MI is not well defined. Accordingly, we determined whether RV dysfunction late after MI influences survival beyond traditional risk predictors, including patient age, left ventricular ejection fraction (LVEF), and infarct size.
Methods We studied 147 consecutive patients >30 days after MI (mean age of infarct 6.7 ± 8.2 years) who were referred for contrast-enhanced cardiovascular magnetic resonance imaging. We assessed hazard ratios for death by RV ejection fraction (RVEF). The association of RVEF with mortality adjusted to traditional risk predictors was examined by using multivariable Cox proportional hazards regression models.
Results A total of 26 deaths occurred during a median follow-up of 17 months (range 6 to 53 months). By univariable analysis, RVEF <40% was strongly associated with mortality (unadjusted hazard ratio 4.02; p = 0.0007). By multivariable analysis that adjusted for patient age, left ventricular (LV) infarct size, and LVEF, RVEF <40% remained a significant independent predictor of mortality (adjusted hazard ratio 2.86; p = 0.03).
Conclusions Right ventricular ejection fraction quantified late after MI is an important predictor of prognosis adjusted for patient age, LV infarct size, and LVEF. Accordingly, evaluation of RVEF using cardiovascular magnetic resonance imaging can improve risk-stratification and potentially refine patient management after MI.
↵1 Dr. Larose was partly supported by Le Fonds de la Recherche en Santé du Québec (FRSQ) and the Quebec Association of Cardiologists.
Supported by the Brigham and Women’s Cardiovascular Magnetic Resonance Imaging Fund.
- Received May 18, 2006.
- Revision received October 3, 2006.
- Accepted October 9, 2006.
- American College of Cardiology Foundation