Prognostic impact of right ventricular function after ST-elevation myocardial infarction
O Wachs, O HavakukAbstract
Background
Right ventricular (RV) function has important prognostic implications across cardiovascular pathologies. However, its value after ST-elevation myocardial infarction (STEMI) remains poorly characterized.
Purpose
To determine the prevalence of RV dysfunction in a large STEMI cohort, assess its prognostic impact, and evaluate whether it differs by infarct location.
Methods
Using retrospective data from a large tertiary care center, we assessed routinely-measured echocardiographic parameters of RV function in STEMI patients, specifically tricuspid annular plane systolic excursion (TAPSE) and tricuspid lateral annular peak systolic velocity (S'). The association between RV dysfunction and 30-day heart failure hospitalizations and all-cause mortality was evaluated in the entire STEMI cohort and according to infarct location (anterior vs inferior). Exclusion criteria included previous MI and factors which may affect RV function (implanted pacemaker, previous cardiac surgery, etc.).
Results
Included were 665 patients (79.7% men; mean age 62.5±12.9 years). Reduced TAPSE (<1.7 cm) was present in 13.5%, was similar between anterior and inferior STEMI (14.6% vs 12.5%; p = 0.42), and was associated with worse prognosis (OR 4.30; 95% CI 2.40-7.55). Similarly, reduced S' (<9.5 cm/s) was present in 16.1%, did not differ between anterior and inferior STEMI (16.0% vs 17.3%; p = 0.65), and was associated with adverse outcomes (OR 3.64; 95% CI 2.05-6.48). After adjustment for age, sex, and left ventricular ejection fraction, reduced TAPSE showed similar prognostic impact in both anterior and inferior STEMI (OR 1.74; 95% CI 0.38-7.92, p = 0.48), whereas reduced S' was prognostic only in inferior STEMI.
Conclusions
This is the largest study investigating RV dysfunction and its effect on prognosis across STEMI subtypes. RV dysfunction was prevalent following STEMI and was found to be associated with adverse outcomes across infarct locations. These findings may refine post-STEMI risk stratification and inform clinical decision-making.Prevalence of reduced TAPSE and S'30-day outcomes according to RV function