CARDIAC RADIOLOGY Utility of cardiac magnetic resonance (CMR) in the evaluation of right ventricular (RV) involvement in patients with myocardial infarction (MI) Nicola Galea • Marco Francone • Iacopo Carbone • David Cannata • Francesco Vullo • Roberto Galea • Luciano Agati • Francesco Fedele • Carlo Catalano Received: 25 July 2012 / Accepted: 10 January 2013 Ó Italian Society of Medical Radiology 2013 Abstract Purpose The aim of this work was to compare the prevalence of right ventricle involvement in a population of patients with myocardial infarction as detected by cardiac magnetic resonance (CMR), clinical presentation, electro- cardiographic (ECG) and echocardiographic criteria. Materials and methods A total of 97 consecutive patients, admitted to our institution for acute myocardial infarction, underwent a standard CMR examination within 5 days after the event. The presence of myocardial oedema and late enhancement of the right ventricle were compared to infarct location (anterior vs. inferior), clinical data, ECG, echocardiography results and other CMR findings. The results were analysed statistically using the Student’s t test for independent samples and the K statistic. Results Among the 97 patients included in the study, a diagnosis of right ventricular infarction was established in 12, 14 and 24 cases on the basis of the clinical data, the ECG and echocardiography, respectively. CMR demonstrated myocardial oedema and late enhancement of the right ven- tricle in 48 and 32 cases, respectively. The right ventricle was involved in 46 % of patients with inferior myocardial infarction (15/32) and in 30 % with anterior myocardial infarction (17/56), correlating to a worsening of both right and left ventricular performance (p = 0.001–0.05). Conclusions The right ventricle is frequently involved in myocardial infarction, correlating to a worse functional impairment of both ventricles and a worse prognosis. This finding, which is often underestimated by traditional car- diological tests, is well revealed by CMR, with potential clinical and therapeutic impact. Keywords Cardiac magnetic resonance Á Right ventricle Á Ischaemic heart disease Á Acute anterior wall myocardial infarction Á Acute inferior wall myocardial infarction Introduction Acute myocardial infarction (MI) of the right ventricle (RV) is found in almost half of the cases of inferior MI, in 40 % of cases of anterior MI [2], and in only 3 % of cases does it present as an isolated clinical entity [1]. Right ventricle myocardial infarction (RVMI) has a negative prognostic impact in terms of nosocomial mor- tality (a 28 % increase in the case of inferior MI [3]) and it raises by two to three times the risk of major complications such as cardiogenic shock, fatal arrhythmias (i.e. ventric- ular fibrillation or complete atrioventricular block) or mechanical complications like rupture of the interventric- ular septum, heart rupture or cardiac tamponade [2, 4–6]. Furthermore, acute dysfunction of the right ventricle reduces the left venous return and consequently determines N. Galea (&) Á M. Francone Á I. Carbone Á D. Cannata Á F. Vullo Á C. Catalano Dipartmento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Universita ` di Roma ‘‘Sapienza’’, Viale Regina Elena 324, 00161 Rome, Italy e-mail: nicola.galea@gmail.com R. Galea UOC Malattie Cardiovascolari, Fondazione IRCSS Ospedale Maggiore Policlinico Universita ` degli Studi di Milano, Via Francesco Sforza 35, 20122 Milan, Italy L. Agati Á F. Fedele Dipartimento di Scienze Cardiovascolari e Respiratorie, Policlinico Umberto I, Universita ` di Roma ‘‘Sapienza’’, Viale Regina Elena 324, 00161 Rome, Italy 123 Radiol med DOI 10.1007/s11547-013-0341-4