NEW ORLEANS — Patients with severe right ventricular dysfunction following a myocardial infarction had a substantially increased risk of adverse cardiovascular events in an analysis of 522 patients.
“Reduced right ventricular systolic function should be considered a major risk factor” for death, heart failure, stroke, and sudden death following a myocardial infarction, Nagesh S. Anavekar, M.D., said while presenting a poster at the annual scientific sessions of the American Heart Association.
His study used data collected in the Valsartan in Acute Myocardial Infarction Trial (VALIANT), a study that randomized nearly 10,000 acute MI patients to treatment with either valsartan or captopril. The study showed that these two drugs had similar efficacy for reducing cardiac events. The new analysis focused on a subset of 610 patients who underwent two-dimensional echocardiography an average of 5 days following their MIs.
For 522 of these patients, the images collected during echo were good enough to allow Dr. Anavekar and his associates to quantify right ventricular function using the apical, four-chamber view. They calculated the right ventricular fractional area change for each of these patients based on the percent change in right ventricular cavity area from end diastole to end systole. The mean right ventricular fractional area change for all 522 patients was 42%.
The incidence of all-cause death, cardiovascular death, repeat MI, heart failure, stroke, and sudden death was tallied during an average follow-up of about 2 years. There was a strong, inverse correlation between the rate of all of these events except repeat MI and the change in right ventricular fractional area.
In an analysis that controlled for 26 potential confounders, including age, left ventricular ejection fraction, Killip class, and treatment, every 5% drop in right ventricular fractional area change at baseline was associated with a 70% increase in the combined rate of fatal and nonfatal cardiovascular events, said Dr. Anavekar of the cardiovascular division of Brigham and Women's Hospital, Boston. The association was statistically significant.