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Title: Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study).
Austin Authors: Anavekar, Nagesh S;Skali, Hicham;Bourgoun, Mikhail;Ghali, Jalal K;Kober, Lars;Maggioni, Aldo P;McMurray, John J V;Velazquez, Eric;Califf, Robert;Pfeffer, Marc A;Solomon, Scott D
Department of Cardiology, Austin Health, University of Melbourne, Melbourne, Australia
Issue Date: 1-Mar-2008
Publication information: The American Journal of Cardiology; 101(5): 607-12
Abstract: Severe right ventricular dysfunction independent of left ventricular ejection fraction increased the risk of heart failure (HF) and death after myocardial infarction (MI). The association between right ventricular function and other clinical outcomes after MI was less clear. Two-dimensional echocardiograms were obtained in 605 patients with left ventricular dysfunction and/or clinical/radiologic evidence of HF from the VALIANT echocardiographic substudy (mean 5.0 +/- 2.5 days after MI). Clinical outcomes included all-cause mortality, cardiovascular (CV) death, sudden death, HF, and stroke. Baseline right ventricular function was measured in 522 patients using right ventricular fractional area change (RVFAC) and was related to clinical outcomes. Mean RVFAC was 41.9 +/- 4.3% (range 19.2% to 53.1%). The incidence of clinical events increased with decreasing RVFAC. After adjusting for 11 covariates, including age, ejection fraction, and Killip's classification, decreased RVFAC was independently associated with increased risk of all-cause mortality (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.31 to 1.98), CV death (HR 1.62, 95% CI 1.30 to 2.01), sudden death (HR 1.79, 95% CI 1.26 to 2.54), HF (HR 1.48, 95% CI 1.17 to 1.86), and stroke (HR 2.95, 95% CI 1.76 to 4.95), but not recurrent MI. Each 5% decrease in baseline RVFAC was associated with a 1.53 (95% CI 1.24 to 1.88) increased risk of fatal and nonfatal CV outcomes. In conclusion, decreased right ventricular systolic function is a major risk factor for death, sudden death, HF, and stroke after MI.
Gov't Doc #: 18308007
DOI: 10.1016/j.amjcard.2007.09.115
Journal: The American journal of cardiology
Type: Journal Article
Subjects: Death, Sudden
Double-Blind Method
Follow-Up Studies
Heart Failure.epidemiology.physiopathology
Heart Ventricles.ultrasonography
Middle Aged
Myocardial Infarction.epidemiology.physiopathology
Outcome Assessment (Health Care)
Stroke Volume.physiology
Ventricular Dysfunction, Left.epidemiology.physiopathology
Ventricular Dysfunction, Right.epidemiology.physiopathology
Appears in Collections:Journal articles

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