Key result
RV global longitudinal strain predicts ~5% higher 12-month MACE risk in myocardial infarction patients.
Why the study?
Right ventricular involvement complicating myocardial infarction is thought to impact prognosis, but potent right ventricular markers for risk stratification are lacking.
Does right ventricular global longitudinal strain assessment predict major adverse cardiac events in patients with acute myocardial infarction?
Cohort (n=1,235)
Masked core laboratory
Does right ventricular global longitudinal strain assessment predict major adverse cardiac events in patients with acute myocardial infarction?
Hazard Ratio: 1.05 (95% CI 1–1.09)
Absolute Event Rate: 10.2% vs 3.8%
p-value: p=0.034
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.
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%; p<0.001) 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
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Stiermaier et al. (2020) conducted a cohort in Myocardial infarction (n=1,235). Right ventricular global longitudinal strain (RV GLS) vs. Below median RV GLS was evaluated on 12-month rate of major adverse cardiac events (MACE) (HR 1.05, 95% CI 1.00-1.09, p=0.034). 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.
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