Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction
BackgroundThe frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known.Materials and MethodsOne...
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description | BackgroundThe frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known.Materials and MethodsOne hundred seven consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging (TDI) within 72 hours after a successful primary percutaneous coronary intervention to assess their RV function. Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55.ResultsGlobal RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20–9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18–0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0–1.02; P = 0.039) were independently associated with the presence of global RV dysfunction.ConclusionsIn patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics. |
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Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55.ResultsGlobal RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20–9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18–0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0–1.02; P = 0.039) were independently associated with the presence of global RV dysfunction.ConclusionsIn patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics.</description><identifier>ISSN: 1081-5589</identifier><identifier>EISSN: 1708-8267</identifier><identifier>DOI: 10.2310/JIM.0b013e3182857edf</identifier><identifier>PMID: 23392056</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Cardiovascular disease ; Clinical medicine ; Diabetes ; Echocardiography ; Electrocardiography ; Female ; Heart attacks ; Humans ; Hyperglycemia ; Hyperglycemia - blood ; Hyperglycemia - complications ; Hyperglycemia - physiopathology ; Laboratories ; Male ; Middle Aged ; Mortality ; Myocardial Infarction - blood ; Myocardial Infarction - complications ; Myocardial Infarction - physiopathology ; Myocardial Reperfusion Injury - blood ; Myocardial Reperfusion Injury - complications ; Myocardial Reperfusion Injury - physiopathology ; Pulmonary hypertension ; Studies ; Ventricular Dysfunction, Right - blood ; Ventricular Dysfunction, Right - complications ; Ventricular Dysfunction, Right - physiopathology</subject><ispartof>Journal of investigative medicine, 2013-04, Vol.61 (4), p.715-721</ispartof><rights>2015 American Federation for Medical Research, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>2013 American Federation for Medical Research</rights><rights>Copyright: 2015 (c) 2015 American Federation for Medical Research, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b417t-90fa5ffaa98b8eb6077e8cbb8b44cac57d2b2ac3a469327cbb2b4ba8a5e31c563</citedby><cites>FETCH-LOGICAL-b417t-90fa5ffaa98b8eb6077e8cbb8b44cac57d2b2ac3a469327cbb2b4ba8a5e31c563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.2310/JIM.0b013e3182857edf$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.2310/JIM.0b013e3182857edf$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21817,27922,27923,43619,43620</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23392056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hsu, Shun-Yi</creatorcontrib><creatorcontrib>Chang, Shang-Hung</creatorcontrib><creatorcontrib>Liu, Chih-Jen</creatorcontrib><creatorcontrib>Lin, Jeng-Feng</creatorcontrib><creatorcontrib>Ko, Yu-Lin</creatorcontrib><creatorcontrib>Cheng, Shih-Tsung</creatorcontrib><creatorcontrib>Chou, Hsin-Hua</creatorcontrib><creatorcontrib>Chang, Heng-Chia</creatorcontrib><title>Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction</title><title>Journal of investigative medicine</title><addtitle>J Investig Med</addtitle><description>BackgroundThe frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known.Materials and MethodsOne hundred seven consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging (TDI) within 72 hours after a successful primary percutaneous coronary intervention to assess their RV function. Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55.ResultsGlobal RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20–9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18–0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0–1.02; P = 0.039) were independently associated with the presence of global RV dysfunction.ConclusionsIn patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics.</description><subject>Cardiovascular disease</subject><subject>Clinical medicine</subject><subject>Diabetes</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>Hyperglycemia - blood</subject><subject>Hyperglycemia - complications</subject><subject>Hyperglycemia - physiopathology</subject><subject>Laboratories</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Reperfusion Injury - blood</subject><subject>Myocardial Reperfusion Injury - complications</subject><subject>Myocardial Reperfusion Injury - physiopathology</subject><subject>Pulmonary hypertension</subject><subject>Studies</subject><subject>Ventricular Dysfunction, Right - blood</subject><subject>Ventricular Dysfunction, Right - complications</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><issn>1081-5589</issn><issn>1708-8267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkctq3TAURU1paR7tH5Qi6KQTJ3ra0jBckvSGhIbQx9AcyVKii23dSvIg39KfrRKnaQmlZCSB1trnoF1V7wg-oIzgw7P1xQHWmDDLiKRStLZ3L6pd0mJZS9q0L8sdS1ILIdVOtZfSBmPaCEVfVzuUMUWxaHarn6sQox0g24SCQ-txCz7aHp0OQcOArvz1TUbf7JSjN_MAEZ3Mk8k-TMhP6BKyL08Jfff5BgG6slsb3ZyKf2TmbNHFbTAQe1-S1pODuJgw9fdGmPM_BvwB31SvHAzJvn0496uvJ8dfVp_q88-n69XRea05aXOtsAPhHICSWlrd4La10mgtNecGjGh7qikYBrxRjLblhWquQYIoP2dEw_arj0vuNoYfs025G30ydhhgsmFOHWFENYwqcod-eIJuwhynsl1HWtkoyjnlheILZWJIKVrXbaMfId52BHd35XWlvO5peUV7_xA-69H2j9LvtgpAFiDBtf1r8v9DDxdHj5vnrfELX-m3ag</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Hsu, Shun-Yi</creator><creator>Chang, Shang-Hung</creator><creator>Liu, Chih-Jen</creator><creator>Lin, Jeng-Feng</creator><creator>Ko, Yu-Lin</creator><creator>Cheng, Shih-Tsung</creator><creator>Chou, Hsin-Hua</creator><creator>Chang, Heng-Chia</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AM</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGRYB</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K7.</scope><scope>K9.</scope><scope>M0O</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction</title><author>Hsu, Shun-Yi ; Chang, Shang-Hung ; Liu, Chih-Jen ; Lin, Jeng-Feng ; Ko, Yu-Lin ; Cheng, Shih-Tsung ; Chou, Hsin-Hua ; Chang, Heng-Chia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b417t-90fa5ffaa98b8eb6077e8cbb8b44cac57d2b2ac3a469327cbb2b4ba8a5e31c563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Cardiovascular disease</topic><topic>Clinical medicine</topic><topic>Diabetes</topic><topic>Echocardiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>Hyperglycemia - blood</topic><topic>Hyperglycemia - complications</topic><topic>Hyperglycemia - physiopathology</topic><topic>Laboratories</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Reperfusion Injury - blood</topic><topic>Myocardial Reperfusion Injury - complications</topic><topic>Myocardial Reperfusion Injury - physiopathology</topic><topic>Pulmonary hypertension</topic><topic>Studies</topic><topic>Ventricular Dysfunction, Right - blood</topic><topic>Ventricular Dysfunction, Right - complications</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsu, Shun-Yi</creatorcontrib><creatorcontrib>Chang, Shang-Hung</creatorcontrib><creatorcontrib>Liu, Chih-Jen</creatorcontrib><creatorcontrib>Lin, Jeng-Feng</creatorcontrib><creatorcontrib>Ko, Yu-Lin</creatorcontrib><creatorcontrib>Cheng, Shih-Tsung</creatorcontrib><creatorcontrib>Chou, Hsin-Hua</creatorcontrib><creatorcontrib>Chang, Heng-Chia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Criminal Justice Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Criminology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Criminal Justice Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of investigative medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsu, Shun-Yi</au><au>Chang, Shang-Hung</au><au>Liu, Chih-Jen</au><au>Lin, Jeng-Feng</au><au>Ko, Yu-Lin</au><au>Cheng, Shih-Tsung</au><au>Chou, Hsin-Hua</au><au>Chang, Heng-Chia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction</atitle><jtitle>Journal of investigative medicine</jtitle><addtitle>J Investig Med</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>61</volume><issue>4</issue><spage>715</spage><epage>721</epage><pages>715-721</pages><issn>1081-5589</issn><eissn>1708-8267</eissn><abstract>BackgroundThe frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known.Materials and MethodsOne hundred seven consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging (TDI) within 72 hours after a successful primary percutaneous coronary intervention to assess their RV function. Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55.ResultsGlobal RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20–9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18–0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0–1.02; P = 0.039) were independently associated with the presence of global RV dysfunction.ConclusionsIn patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>23392056</pmid><doi>10.2310/JIM.0b013e3182857edf</doi><tpages>7</tpages></addata></record> |
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subjects | Cardiovascular disease Clinical medicine Diabetes Echocardiography Electrocardiography Female Heart attacks Humans Hyperglycemia Hyperglycemia - blood Hyperglycemia - complications Hyperglycemia - physiopathology Laboratories Male Middle Aged Mortality Myocardial Infarction - blood Myocardial Infarction - complications Myocardial Infarction - physiopathology Myocardial Reperfusion Injury - blood Myocardial Reperfusion Injury - complications Myocardial Reperfusion Injury - physiopathology Pulmonary hypertension Studies Ventricular Dysfunction, Right - blood Ventricular Dysfunction, Right - complications Ventricular Dysfunction, Right - physiopathology |
title | Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction |
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