Background Acute inferior myocardial infarction frequently involvesthe right ventricle. We hypothesized that right ventricularinvolvement, as diagnosed by ST-segment elevation in the rightprecordial lead V4R, may affect the prognosis of patients withinferior myocardial infarctions.
Methods In 200 consecutive patients admitted to the hospitalwith acute inferior myocardial infarctions, we assessed theprevalence and diagnostic accuracy of ST-segment elevation inlead V4R (as compared with four other diagnostic procedures)to identify right ventricular involvement and its prognosticimplications for in-hospital and long-term outcomes.
Results The in-hospital mortality after inferior myocardialinfarction was 19 percent, and major complications occurredin 47 percent of the patients. The presence of ST-segment elevationin lead V4R in 107 patients (54 percent) was highly predictiveof right ventricular infarction (sensitivity, 88 percent; specificity,78 percent; diagnostic accuracy, 83 percent), as compared withthe other diagnostic procedures. The patients with ST-segmentelevation in lead V4R had a higher in-hospital mortality rate(31 percent vs. 6 percent, P<0.001) and a higher incidenceof major in-hospital complications (64 percent vs. 28 percent,P<0.001) than did those without ST elevation in V4R. Multiplelogistic-regression analysis showed ST elevation in V4R to beindependent of and superior to all other clinical variablesavailable on admission for the prediction of in-hospital mortality(relative risk, 7.7; 95 percent confidence interval, 2.6 to23) and major complications (relative risk, 4.7; 95 percentconfidence interval, 2.4 to 9). The post-hospital course (follow-up,at least 1 year; mean follow-up, 37 months) was similar in patientswith and in those without electrocardiographic evidence of rightventricular infarction.
Conclusions Right ventricular involvement during acute inferiormyocardial infarction can be accurately diagnosed by the presenceof ST-segment elevation in lead V4R, a finding that is a strong,independent predictor of major complications and in-hospitalmortality. Electrocardiographic assessment of right ventricularinfarction should be routinely performed in all patients withacute inferior myocardial infarctions.
Source Information
From the Abteilung fur Kardiologie, Innere Medizin III (M.Z., W.K., E.K., M.S., A.G., H.J.), and the Abteilung fur Medizinische Biometrie und Informatik (M.O.), Universitatsklinik Freiburg, Freiburg, Germany.
Address reprint requests to Dr. Zehender at Innere Medizin III, Universitatsklinik Freiburg, Hugstetterstr. 55, 78 Freiburg, Germany.
Single-Drug Therapy for Hypertension in Men
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N Engl J Med 1993;
329:1043-1045, Sep 30, 1993.
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[Full Text]
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100: 761-767
[Abstract][Full Text]
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(1999). Cardiogenic Shock. ANN INTERN MED
131: 47-59
[Abstract][Full Text]
Wellens, H. J.J.
(1999). The Value of the Right Precordial Leads of the Electrocardiogram. NEJM
340: 381-383
[Full Text]
Ribichini, F., Steffenino, G., Dellavalle, A., Ferrero, V., Vado, A., Feola, M., Uslenghi, E.
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32: 1687-1694
[Abstract][Full Text]
Bueno, H., Lopez-Palop, R., Perez-David, E., Garcia-Garcia, J., Lopez-Sendon, J. L., Delcan, J. L.
(1998). Combined Effect of Age and Right Ventricular Involvement on Acute Inferior Myocardial Infarction Prognosis. Circulation
98: 1714-1720
[Abstract][Full Text]
Zeymer, U., Neuhaus, K.-L., Wegscheider, K., Tebbe, U., Molhoek, P., Schroder, R., for the HIT-4 Trial Group,
(1998). Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement. J Am Coll Cardiol
32: 876-881
[Abstract][Full Text]
Mueller, H. S., Chatterjee, K., Davis, K. B., Fifer, M. A., Franklin, C., Greenberg, M. A., Labovitz, A. J., Shah, P. K., Tuman, K. J., Weil, M. H., Weintraub, W. S., Forrester, J. S., Douglas, P. S., Faxon, D. P., Fisher, J. D., Gibbons, R. J., Halperin, J. L., Hochman, J. S., Hutter, A. M. Jr., Kaul, S., Weintraub, W. S., Winters, W. L. Jr., Wolk, M. J.
(1998). Present use of bedside right heart catheterization in patients with cardiac disease. J Am Coll Cardiol
32: 840-864
[Full Text]
White, H. D., Van de Werf, F. J. J.
(1998). Thrombolysis for Acute Myocardial Infarction. Circulation
97: 1632-1646
[Abstract][Full Text]
Bowers, T. R., O'Neill, W. W., Grines, C., Pica, M. C., Safian, R. D., Goldstein, J. A.
(1998). Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular Infarction. NEJM
338: 933-940
[Abstract][Full Text]
Shiraki, H., Yoshikawa, T., Anzai, T., Negishi, K., Takahashi, T., Asakura, Y., Akaishi, M., Mitamura, H., Ogawa, S.
(1998). Association between Preinfarction Angina and a Lower Risk of Right Ventricular Infarction. NEJM
338: 941-947
[Abstract][Full Text]
Dell'Italia, L. J.
(1998). Reperfusion for Right Ventricular Infarction. NEJM
338: 978-980
[Full Text]
Elvan, A., Zipes, D. P.
(1998). Right Ventricular Infarction Causes Heterogeneous Autonomic Denervation of the Viable Peri-infarct Area. Circulation
97: 484-492
[Abstract][Full Text]
Bishop, A., White, P., Groves, P., Chaturvedi, R., Brookes, C., Redington, A., Oldershaw, P.
(1997). Right ventricular dysfunction during coronary artery occlusion: pressure-volume analysis using conductance catheters during coronary angioplasty. Heart
78: 480-487
[Abstract][Full Text]
Bueno, H., Lopez-Palop, R., Bermejo, J., Lopez-Sendon, J. L., Delcan, J. L.
(1997). In-Hospital Outcome of Elderly Patients With Acute Inferior Myocardial Infarction and Right Ventricular Involvement. Circulation
96: 436-441
[Abstract][Full Text]
David, T. E., Dale, L., Sun, Z.
(1995). POSTINFARCTION VENTRICULAR SEPTAL RUPTURE: REPAIR BY ENDOCARDIAL PATCH WITH INFARCT EXCLUSION. J. Thorac. Cardiovasc. Surg.
110: 1315-1322
[Abstract][Full Text]
COMMITTEE MEMBERS, , WILLIAMS, J. F. Jr, BRISTOW, M. R., FOWLER, M. B., FRANCIS, G. S., GARSON, A. Jr, GERSH, B. J., HAMMER, D. F., HLATKY, M. A., LEIER, C. V., PACKER, M., PITT, B., ULLYOT, D. J., WEXLER, L. F., WINTERS, W. L. Jr, TASK FORCE MEMBERS, , RITCHIE, J. L., CHEITLIN, M. D., EAGLE, K. A., GARDNER, T. J., GARSON, A. Jr, GIBBONS, R. J., LEWIS, R. P., O'ROURKE, R. A., RYAN, T. J.
(1995). Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure). Circulation
92: 2764-2784
[Full Text]
Nagahama, Y., Sugiura, T., Takehana, K., Tarumi, N., Iwasaka, T., Inada, M.
(1995). PQ Segment Depression in Acute Q Wave Inferior Wall Myocardial Infarction. Circulation
91: 641-644
[Abstract][Full Text]
Califf, R. M., Bengtson, J. R.
(1994). Cardiogenic Shock. NEJM
330: 1724-1730
[Full Text]
Kinch, J. W., Ryan, T. J.
(1994). Right Ventricular Infarction. NEJM
330: 1211-1217
[Full Text]
Shah, P. K., Zehender, M.
(1993). Right Ventricular Infarction. NEJM
329: 1043-1043
[Full Text]
Wellens, H. J.J.
(1993). Right Ventricular Infarction. NEJM
328: 1036-1038
[Full Text]
