Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging of Right Ventricular Infarction

• Published in: Journal of the American College of Cardiology 2006-11, Vol.48 (10), p.1969-1976
• Main Authors: Kumar, Andreas, Abdel-Aty, Hassan, Kriedemann, Ilka, Schulz-Menger, Jeanette, Gross, C. Michael, Dietz, Rainer, Friedrich, Matthias G.
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Biological and medical sciences; Blood pressure; Cardiology; Cardiology. Vascular system; Contrast Media; Coronary Angiography; Coronary heart disease; Echocardiography; Electrocardiography; Emergency medical care; Female; Follow-Up Studies; Heart; Heart attacks; Heart Ventricles; Humans; Image Enhancement; Intensive care; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - diagnosis; Observer Variation; Physical Examination; Prospective Studies; Veins & arteries
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.05.078

Contrast-Enhanced Cardiovascular Magnetic Resonance Imaging of Right Ventricular Infarction Andreas Kumar, Hassan Abdel-Aty, Ilka Kriedemann, Jeanette Schulz-Menger, C. Michael Gross, Rainer Dietz, Matthias G. Friedrich We prospectively examined the feasibility of late enhancement cardiovascular magnetic resonance imaging (LE-CMR) for the detection of right ventricular infarction (RVI) in 37 patients with acute inferior myocardial infarction. The LE-CMR was consistent with RVI in 21 patients, electrocardiogram (ECG) in 13, echocardiography in 6, and physical examination in 7; the LE-CMR data showed mild agreement with physical findings for RVI and the ECG and echocardiography data. The LE-CMR findings yielded very good interobserver variability and persisted at long-term follow-up. Late enhancement cardiovascular magnetic resonance imaging thus might allow for a better understanding of the incidence and impact of RV infarction. We assessed the role of late enhancement cardiovascular magnetic resonance imaging (LE-CMR) for the diagnosis of right ventricular infarction (RVI). 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. 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. 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). In patients wit