June 4, 2026European Heart Journal5 citationsOpen Access
Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction
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Key Result
Right ventricular global longitudinal strain was an independent predictor of 12-month major adverse cardiac events (HR 1.05; 95% CI 1.00-1.09; p=0.034) in patients with myocardial infarction.
Key Points
- This research aims to evaluate the frequency and prognostic impact of right ventricular involvement in patients with myocardial infarction.
- Cardiac magnetic resonance was performed on 1235 myocardial infarction patients.
- Assessments included structural and functional right ventricular alterations.
- The clinical endpoint was the 12-month rate of major adverse cardiac events.
- RV ischemia and infarction were noted in 19.6% and 12.1% of patients, respectively.
- Patients with RV ischemia had a higher MACE rate of 10.1% compared to 6.2% without (p=0.035).
- RV GLS was identified as an independent predictor of adverse outcomes (HR 1.05, 95% CI 1.00–1.09; p=0.034).
Study Design
Type
Cohort (n=1,235)
Blinding
Masked core laboratory
Structured PICO
Does right ventricular global longitudinal strain assessment predict major adverse cardiac events in patients with acute myocardial infarction?
P
Population
1,235 patients with myocardial infarction (STEMI and NSTEMI) who underwent cardiac magnetic resonance 3 days after primary percutaneous coronary intervention, followed for 12 months.
E
Exposure
Cardiac magnetic resonance (CMR) assessment of right ventricular (RV) structural and functional alterations (including RV global longitudinal strain)
O
Outcome
12-month rate of major adverse cardiac events (MACE)composite
Right ventricular global longitudinal strain assessed by CMR is an independent predictor of 12-month major adverse cardiac events in patients with acute myocardial infarction, providing prognostic value beyond established risk factors.
Main Result
Hazard Ratio: 1.05 (95% CI 1–1.09)
Absolute Event Rate: 10.2% vs 3.8%
p-value: p=0.034
Abstract
Abstract Background Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking. Purpose To assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI. Methods Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (STEMI: n=795; NSTEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (edema representing reversible ischemia, irreversible infarction, microvascular obstruction MVO) and functional (ejection fraction, global longitudinal strain GLS) RV alterations. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE). Results RV ischemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischemia was associated with a significantly increased risk of MACE (10.1% versus 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% versus 3.8%; p0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (hazard ratio 1.05, 95% confidence interval 1.00–1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020), and left ventricular GLS (p=0.001), while RV ischemia was not independently associated with outcome. Conclusions RV GLS is a predictor of post-infarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome. Funding Acknowledgement Type of funding source: None