Key result
Right ventricular dysfunction markers including lower TAPSE and RVFAC strongly predict 6-month MACE.
Why the study?
Right ventricular infarction complicates one-third of inferior STEMIs, but the in-hospital and long-term prognostic value of RV function needed evaluation.
Does right ventricular function assessed by echocardiography predict major adverse cardiac events in patients with acute inferior STEMI treated with primary angioplasty?
Cohort (n=247)
Does right ventricular function assessed by echocardiography predict major adverse cardiac events in patients with acute inferior STEMI treated with primary angioplasty?
Echocardiographic indices of right ventricular diastolic and systolic function, specifically E' wave velocity, E/E', RVFAC, and TAPSE, are strong independent predictors of MACE in patients with inferior STEMI.
May aid post-PCI risk stratification in inferior STEMI; hypothesis-generating and requires prospective validation.
PURPOSE: Right ventricular (RV) infarction complicates one-third of inferior ST-segment elevation myocardial infarctions (STEMI). Our aim was to evaluate RV function to assess its in-hospital and long-term prognostic value. METHODS: We enrolled 247 patients with inferior STEMI treated with primary angioplasty. Echocardiography was performed within 48 h and after 6 months, including RV myocardial performance index (RVMPI), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVGLS), and pulmonary artery systolic pressure (PASP). Major adverse cardiac events (MACE) were reported during the 6-month follow-up. The patients were categorized into MACE and non-MACE groups. RESULTS: In patients with MACE, RV diastolic dysfunction occurred earlier as evidenced by lower E' wave velocity (5.8 ± 1.03 vs. 9.1 ± 2.8 cm/s, p = 0.04) and higher E/E' (10.1 ± 3.1 vs. 6.1 ± 2.3, p = 0.03). After 6 months, distorted RV geometry and RV systolic dysfunction, evidenced by lower RVFAC (32.2 ± 3.6% vs. 38.06 ± 3.9%, p = 0.04), lower TAPSE (14.6 ± 1.2 vs. 17.3 ± 1.7 mm, p = 0.02), higher RVGLS (-14.5 ± 2.6% vs. -17.5 ± 1.2%, p = 0.04), and higher PASP (29.8 ± 3.2 vs. 24.1 ± 2.2 mmHg, p = 0.01), were reported later on. Multivariate analysis documented E' wave velocity, E/E', RVFAC, and TAPSE as strong predictors of MACE. CONCLUSION: In inferior STEMI, RV diastolic dysfunction occurs earlier in patients with MACE. However, RV systolic dysfunction and impaired RV geometry develop later on. E' wave velocity, E/E', RVFAC, and TAPSE are strong independent predictors of MACE.
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Refaat et al. (2025) conducted a cohort in Acute Inferior ST Elevation Myocardial Infarction (n=247). Right ventricular dysfunction (echocardiographic parameters) vs. Normal right ventricular function was evaluated on Major adverse cardiac events (MACE). Echocardiographic markers of right ventricular dysfunction, such as lower TAPSE (14.6 vs 17.3 mm, p=0.02) and RVFAC (32.2% vs 38.1%, p=0.04), were strong independent predictors of MACE at 6 months.
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