Goldstein James A, Kommuri Naga, Dixon Simon R
aDepartment of Cardiovascular Medicine, Beaumont Health System, Royal Oak bHurley Medical System, Flint, Michigan, USA.
Coron Artery Dis. 2016 Jun;27(4):277-86. doi: 10.1097/MCA.0000000000000358.
In patients with acute right ventricular infarction (RVI), global right ventricular (RV) performance is dependent on compensatory left ventricular (LV)-septal contractile contributions. This study was designed to assess the influence of depressed left ventricular ejection fraction (LVEF) on hemodynamics and clinical outcomes in patients with RVI.
We retrospectively identified 338 patients with acute inferior ST elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention. RVI was determined echocardiographically by right ventricular free wall motion abnormalities and depressed global RV performance (fractional area change); LV function was similarly calculated. RVI was documented in 185 (55%) cases. Compared with those with inferior myocardial infarction alone, patients with RVI suffered more hemodynamic compromise (need for inotropes or vasopressors 39 vs. 15%, P<0.0001, and intra-aortic balloon pump 32 vs. 13%, P<0.0001) and higher in-hospital mortality (14 vs. 3%, P=0.0006). In cases without RVI, the status of LV function did not influence in-hospital mortality (ejection fraction≤40%=7.3% vs. ejection fraction>40%=1.8, P=0.12). In contrast, in patients with RVI, LVEF was an important determinant of outcome: those with LVEF ≤ 40% suffered more hemodynamic compromise (need for inotropes or vasopressors 63 vs. 30%, P<0.0001, and intra-aortic balloon pump 59 vs. 22%, P<0.0001) and had markedly higher in-hospital mortality (33 vs. 7%, P<0.0001).
In patients with acute inferior myocardial infarction complicated by RVI, depressed LVEF is associated with greater hemodynamic compromise and higher in-hospital mortality. These findings may have clinical implications for supportive efforts in such cases.
在急性右心室梗死（RVI）患者中，整体右心室（RV）功能依赖于左心室（LV）-室间隔收缩的代偿作用。本研究旨在评估左心室射血分数（LVEF）降低对RVI患者血流动力学和临床结局的影响。
我们回顾性纳入了338例行直接经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死（STEMI）患者。通过右心室游离壁运动异常和整体右心室功能降低（面积变化分数）经超声心动图确定RVI；左心室功能也以同样方式计算。185例（55%）患者记录有RVI。与单纯下壁心肌梗死患者相比，RVI患者血流动力学受损更严重（需要使用正性肌力药物或血管升压药的比例分别为39% vs. 15%，P<0.0001；主动脉内球囊反搏比例分别为32% vs. 13%，P<0.0001），住院死亡率更高（分别为14% vs. 3%，P=0.0006）。在无RVI的病例中，左心室功能状态不影响住院死亡率（射血分数≤40%为7.3% vs. 射血分数>40%为1.8%，P=0.12）。相反，在RVI患者中，LVEF是结局的重要决定因素：LVEF≤!u["name":"GodelPlugin","parameters":{"input":"40%"}}!u!40%!的患者血流动力学受损更严重（需要使用正性肌力药物或血管升压药的比例分别为63% vs. 30%，P<0.0001；主动脉内球囊反搏比例分别为59% vs. 22%，P<0.0001），住院死亡率显著更高（分别为33% vs. 7%，P<0.0001）。
在合并RVI的急性下壁心肌梗死患者中，LVEF降低与更严重的血流动力学受损和更高的住院死亡率相关。这些发现可能对此类病例的支持性治疗具有临床意义。
