Russian Heart Failure Journal 2010year Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles
Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles
Saiganov S. A., Grishkin Y. N.
Keywords: myocardial infarction of right ventricle, acute right ventricular failure, acute heart failure, central hemodynamic
DOI: 10.18087/ rhfj.2010.3.1330
Topicality. Myocardial infarction of both ventricles is often complicated by hemodynamic disorders with adverse prognosis. Understanding the process of acute HF (AHF) development will allow to optimize treatment approaches and find more rational way of hemodynamic disorders correction. Objective. To study mechanisms of hemodynamic disorders in patients with myocardial infarction of both ventricles during first day of disease and in dynamics. Materials and methods. We examined 76 patients with inferior MI. 41 patients with MI of both ventricles, complicated by acute right ventricular failure (ARVHF), were in group A. Group B (control) included 35 patients with inferior MI with no signs of AHF and RV infarction. Echocardiography was performed in all 76 patients during first day, and was repeated for group A on 4-th day. Invasive hemodynamic monitoring in group A was carried out during first four days of the disease. Results. In group A, in addition to extended right heart chambers, there was larger area of LV damage (39.9±0.97% vs 26.7±0.89% in group B, p<0.05). LV ejection fraction in group A was lower than in control group (37.5±0,88% and 52.6±1.09% respectively, p<0.05). In group A increase of transverse heart size (due to enlarged LV from 52.3±0.58 up to 55.1±0.58 mm) was revealed on the 4-th day from the beginning of MI. That was be evidence of pericardium stretching and improvement of LV blood filling. At baseline there was pulmonary hypotension and elevated central venous pressure (CVP) in group A On the 4-th day pulmonary artery pressure (PAP) increased from baseline (16.2±0.21) to 20.2±0.37 mm Hg with decrease of CVP (from 11.2±0.25 to 8.8±0.19 mm Hg). So the difference between PAP and CVP increased, that was the result of RV increased contractility. PAP positive dynamics led to improved perfusion of organs and tissues. Thus, the main reasons for AHF development in patients with MI with involvement of both ventricles are ARVHF (with decreased blood return to LV) and LV weakness (caused by extensive zone of LV damage and lack of infill). By 4-th day LV infill increases due to improved RV contractility and pericardium tension.
- Brodie BR, Stuckey TD, Hansen C et al. Comparison of late survival in patients with cardiogenic shock due to right ventricular infarction versus left ventricular pump failure following primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am J Cardiol. 2007;99 (4):):431–435.
- Mendes LA, Picard MH, Sleeper LA et al. Cardiogenic shock: predictors of outcome based on right and left ventricular size and function at presentation. Coronary Artery Disease. 2005;16 (4):209–215.
- Ганелина И. Е. Атеросклероз коронарных артерий и ишемическая болезни болезнь сердца. – СПб.: «Наука»,», 2004. – 260 c.
- Kukla P, Dudek D, Rakowski T. Inferior wall myocardial infarction with or without right ventricular involvement – treatment and in-hospital course. Kardiologia. 2006;64 (6):583–588.
- Isner JM. Right ventricular myocardial infarction. In: Konstam MA, Isner JM, eds. The right ventricle. – Boston, «Kluwer Academic». 1988. – Р.:87–129.
- Jacobs AK, Leopold JA, Bates E et al. Cardiogenic Shock Caused by Right Ventricular Infarction. A Report From the SHOCK Registry. J Am Coll Cardiol. 2003;41 (8):1273–1279.
- Сыркин А. Л. Инфаркт миокарда. – 3‑е изд., перераб. и доп.-. – М.: «Мед. информ. агентство», 2003. – 466 с.
- Mehta SR, Eikelboom JV, Natarajan MK, et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol. 2001;;37 (1):37–43.
- Romand JA, Donald FA, Suter PM. Acute right ventricular failure, pathophysiology and treatment. Monaldi Archives for chest disease. 1995;50 (2):129–133.
- Pfisterer M. Right ventricular involvement in myocardial infarction and cardiogenic shock. Lancet. 2003;362 (9381):392–394.
- Larose E, Ganz P, Reynolds HG et al. Right ventricular dysfunction assessed by cardiovascular magnetic resonance imaging predicts poor prognosis late after myocardial infarction. J Am Coll Cardiol. 2007;49 (8):855–862.
- Денисенко Б. А., Гольдберг Г. А., Дробышев Ю. П. Инфаркт миокарда правого и левого желудочков. – Новосибирск, 1987. – 225 c.
- Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction: clinical and hemodynamic features. The American journal of cardiology. 1974;33 (2):209–214.
- Cohn JN. Right ventricular infarction revisited. The American journal of cardiology. 1979;43 (5):666–668.
- Giesler GM, Gomez JS, Letsou G et al. Initial report of percutaneous right ventricular assist for right ventricular shock secondary to right ventricular infarction. Catheterization and cardiovascular Interventions. 2006;68 (2):263–266.
- Соплевенко А. В., Астахова 3. Т., Мосин Л. М. и др. Показатели центральной гемодинамики у больных инфарктом миокарда обеих желудочков. Южно-Российский медицинский журнал. 2000; (5-6):34–37.
- Ratliff NB, Hackel DB. Combined right and left ventricular infarction: pathogenesis and clinicopathologic correlation. Am J Cardiol. 1980;45 (2):217–221.
- Wellens HJJ. Right ventricular infarction. N Engl J Med. 1993;328 (14):1036–1038.
- Михалева Ю. Б., Курапеев И. С., Лебединский К. М. Оценка преднагрузки сердца: развитие методов и эволюция представлений. Анестезиология и реаниматология. 2009;2:45–48.
- Kulbertus HE, Rigo P, Legrand V. Right ventricular infarction: Pathophysiology, diagnosis, clinical course and treatment. Modern Concepts of Cardiovascular Disease. 1985;54 (1):1–5.
- Isner JM, Roberts WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary artery disease: frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol. 1978;42 (7):885–894.
- Lim ST, Goldstein JA. Right ventricular infarction. Am Heart J 2001;3 (1):95–101.
- Ramzy IS, O’Sullivan CA, Lam YY et al. Right ventricular stunning in inferior myocardial infarction. Int J Cardiol. 2009;136 (3):294–299.
Saiganov S. A., Grishkin Y. N. Hemodynamic characteristics of acute heart failure in patients with myocardial infarction of right and left ventricles. Russian Heart Failure Journal. 2010;11(3):148-152.