What is the clinical evidence from this study?

Study design: Cohort. Population: inferior ST-segment elevation myocardial infarction (n=207). Intervention: Right ventricular strain and TAPSE. Primary outcome: all-cause mortality (HR 1.68, 95% CI 1.27-2.23, p=<0.001).

February 25, 2025Open Access

Right ventricular strain and tricuspid annular plane systolic excursion are associated with mortality in inferior ST‐elevation myocardial infarction

Q: What are the key findings of this study?

Right ventricular global longitudinal strain (HR 1.68), free wall strain (HR 1.56), and TAPSE (HR 1.55) were significantly associated with all-cause mortality in patients with inferior STEMI.

Key Result

Right ventricular global longitudinal strain (HR 1.68), free wall strain (HR 1.56), and TAPSE (HR 1.55) were significantly associated with all-cause mortality in patients with inferior STEMI.

Study Design

Type

Cohort (n=207)

Structured PICO

Are right ventricular strain and TAPSE associated with mortality in patients with inferior ST-elevation myocardial infarction?

Population

207 consecutive patients presenting with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention, median age 59.0 years, 69.6% male.

Intervention

Assessment of right ventricular function parameters (tricuspid annular plane systolic excursion [TAPSE], free wall strain [FWS], and global longitudinal strain [RVGLS])

Outcome

All-cause mortalityhard clinical

Right ventricular strain and TAPSE provide crucial prognostic information for long-term mortality in patients with inferior STEMI undergoing PCI.

Main Result

Effect estimate: HR 1.68 (95% CI 1.27-2.23)

p-value: p=<0.001

Abstract

BACKGROUND: Patients with inferior ST-segment elevation myocardial infarction face a substantial risk for cardiovascular death. While left ventricular function is known to be associated with clinical outcomes in these patients, we evaluated the prognostic impact of tricuspid annular plane systolic excursion (TAPSE) and advanced measures of right ventricular function (free wall strain FWS and global longitudinal strain RVGLS). METHODS: Consecutive patients presenting with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention between 01/2012 and 08/2015 were retrospectively analysed. Associations between RV strain measurements and all-cause mortality were evaluated using Cox regression analysis. RESULTS: 207 patients (69.6% male, median 59.0 IQR: 52.1-70.7 years) were followed for 8.3 (IQR: 7.4-9.3) years, during which 49 patients (23.7%) deceased. Median right ventricular function parameters were significantly better in surviving patients (RVGLS: -17.5% vs. -13.3%, p < .001; FWS: -20.5% vs. -14.8%, p < .001; TAPSE 1.8 cm vs. 1.3 cm, p < .001). All 3 parameters were associated with mortality in univariate and multivariable analysis adjusted for age, sex and the number of comorbidities (chronic kidney disease, hypercholesterinaemia, diabetes mellitus) (adj. hazard ratio HR per 1 standard deviation: RVGLS: 1.68 95% CI: 1.27-2.23, p < .001, FWS: 1.56 95% CI: 1.56-2.00, p < .001, TAPSE: 1.55 95% CI: 1.17-2.05, p = .002). Additionally, right ventricular function was inversely associated with peak troponin T and creatine kinase levels. CONCLUSIONS: Among patients with inferior ST-segment myocardial infarction, RVGLS, FWS and TAPSE convey crucial prognostic information and might help to identify patients at increased risk requiring intensified monitoring and therapy.