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Correlates of Impaired Global Right Ventricular Function in Patients With a Reperfused Acute Myocardial Infarction and Without Right Ventricular Infarction
  1. Shun-Yi Hsu, MD*†,
  2. Shang-Hung Chang, MD, PhD,
  3. Chih-Jen Liu, MD*,
  4. Jeng-Feng Lin, MD*†,
  5. Yu-Lin Ko, MD, PhD*†,
  6. Shih-Tsung Cheng, MD*,
  7. Hsin-Hua Chou, MD*,
  8. Heng-Chia Chang, MD*
  1. From the *Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan; †Tzu Chi University College of Medicine, Hualien, Taiwan; and ‡Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
  1. Received November 7, 2012, and in revised form December 16, 2012.
  2. Accepted for publication December 30, 2012.
  3. Reprints: Heng-Chia Chang, MD, Division of Cardiology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan, 289 Jianguo Rd, Xindian City, New Taipei, Taiwan. E-mail: shunyi57{at}
  4. Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare.


Background The 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 Methods One 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.

Results Global 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.

Conclusions In 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.

Key Words
  • right ventricular function
  • acute myocardial infarction
  • tissue Doppler imaging
  • hyperglycemia
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