Persistent inhospital right ventricular global and regional systolic dysfunction predicts outcomes in patients with ST elevation myocardial infarction treated with primary coronary intervention

Introduction: Right ventricular dysfunction occurs with a variable prevalence in the setting of an acute ST elevation myocardial infarction (STEMI) irrespective of the culprit coronary artery and is generally rapid re-versible, but little is known about its influence on ad-verse events, especially in the case of lack of recovery of RV functional changes. The purpose of the current study was to evaluate the relation between temporal changes of RV function during hospitalization and ma-jor non-fatal cardiovascular adverse events (MACE) in STEMI patients treated by primary percutaneous inter-vention (PCI), irrespective of infarct location.

Methods: We have prospectively analyzed a cohort of 80 consecutive patients (mean age 61.17 years, 68.8% males) presenting with a first STEMI treated success-fully by PCI. Patients with history of cardiac or pulmo-nary diseases were excluded. All patients underwent conventional echocardiography at admission, before PCI, at 24 hours after the index event and at discharge to assess RV function. RV systolic function was quan-tified with tricuspid annular plane systolic excursion (TAPSE) and RV global function was measured using RV myocardial performance index (RVMPI) through conventional echocardiography. The mean follow up duration was 8.2 ± 0.69 months. The combined en-dpoint of MACE was defined as reinfarction, need for repeat revascularization, hospitalization for heart failu-re or stroke.

Results: The mean followup period was 8.2 ± 0.69 months. During the follow up period 30 patients (37.5%) reached the combined endpoint. Analyzing the predictive value of TAPSE and RVMPI temporal changes during the hospitalization period, using repea-ted measures t test, we found that the lack of recovery of regional systolic or global RV function was signifi-cantly associated with an increased risk of developing MACE during follow up. (p=0.035 for TAPSE respecti-vely p=0.03 for RVMPI).

Conclusions: The lack of improvement of right ventri-cular regional systolic and global function during hos-pitalization for STEMI, independent of infarct location, is predictive of nonfatal adverse events during follow up, improving risk stratification in these categories of patients, by default highlighting the necessity of closer monitoring of these patients. Key words: RV function, MACE, STEMI, PCI.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)