Radiographic findings of patients with right ventricular infarction: prognostic evaluation.

Background: The clinical course of right ventricular infarction and its management differs substantially from the management of left ventricular infarction: early and accurate diagnosis is very important.Methods: The patient population included 204 consecutive patients: 96 had a right ventricular infarction and 108 a left ventricular inferior infarction. A standard chest radiograph was obtained within 10 and 48 h of onset of symptoms. The width of the azygos vein and the presence of extravascular lung water were evaluated and compared. The in-hospital and long-term course (6 months follow-up) was determined for all patients.Results: The width of the azygos vein was significantly greater in patients with right ventricular infarction than in patients with inferior ventricular infarction. An increase in azygos vein width was greater than 13 mm and showed a diagnostic sensitivity of 90% and a specificity of 94%; the positive predictive value for right ventricular infarction was 94%. A ratio between the azygos vein width and an extravascular lung water score of less than 2 indicated a diagnostic sensitivity of 90% and a specificity of 93%. The positive predictive value for right ventricular infarction was 96%. Patients with right ventricular infarction and an azygos vein width greater than the median (16.59 mm) had more hypotension, bradycardia and heart block and a higher mortality than did patients with an azygos vein width smaller than the median.Conclusions: A chest radiograph has been shown to be sensitive and specific for the diagnosis of right ventricular involvement in patients with inferior left ventricular infarction. All patients admitted to Coronary Care Units (CCU) should have access tochest radiography, which should help in the early diagnosis of right ventricular infarction