Author + information
- Sujeeth R. Punnam, MD⁎ ( and )
- Abhijeet Dhoble, MD
- ↵⁎Division of Cardiology, A-205 Clinical Center, Michigan State University, East Lansing, Michigan 48823
Bangalore et al. (1) looked at the prognostic value of right ventricular (RV) asynergy during routine stress echocardiography in patients with known or suspected coronary artery disease and concluded that an abnormal RV can further stratify risk and prognosticate the results. We have 2 concerns with the study. 1) Rest- or stress-induced RV dysfunction and enlargement could also be from primary or secondary pulmonary hypertension apart from coronary artery disease. The investigators did not give any information on chronic obstructive pulmonary disease prevalence in this cohort, which could be a confounding variable and could have an impact on survival. 2) Regional stress-induced RV dysfunction (McConnell sign) (2) is also seen in acute pulmonary embolism apart from RV infarction. Ramanath et al. (3) reported a case of pulmonary embolism that was detected in a patient with a normal resting echocardiogram but a markedly abnormal post-treadmill exercise echocardiogram revealing RV dilatation from a pulmonary embolism. Again, Bangalore et al. (1) did not comment on any risk factors for pulmonary embolism in these patients that could have an impact on survival.
- American College of Cardiology Foundation