Key result
Elevated LV MPI is linked to ~3.4-fold higher odds of early RV dysfunction in STEMI.
Why the study?
The frequency and clinical correlates of global right ventricular dysfunction in patients with first acute STEMI treated by primary PCI without right ventricular infarction are not well known.
Observational (n=107)
Odds Ratio: 3.4 (95% CI 1.2–9.67)
p-value: p=0.022
RV dysfunction occurs in 17% of first STEMI without RV infarction; leaves open whether TDI screening refines early risk stratification.
BACKGROUND: The frequency and clinical correlates of global right ventricular (RV) dysfunction in patients treated with primary percutaneous coronary intervention for a first acute ST-elevation myocardial infarction (STEMI) without a coexisting RV infarction is not well known. MATERIALS AND METHODS: One hundred seven consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging (TDI) within 72 hours after a successful primary percutaneous coronary intervention to assess their RV function. Global RV function was quantified with the RV myocardial performance index (MPI) by pulsed-wave TDI. An abnormal TDI-derived RV MPI was defined as greater than the upper reference limit of 0.55. RESULTS: Global RV dysfunction was present in 18 (17%) of the 107 patients enrolled. The patients with global RV dysfunction had significantly higher glucose levels on admission (216 ± 102 vs 163 ± 86 mg/dL; P = 0.027), higher peak creatine kinase (4027 ± 2171 vs 2660 ± 1980 IU/L; P = 0.014), and more frequently had anterior infarcts (89% vs 58%; P = 0.016) than those without RV dysfunction. Patients with global RV dysfunction also had a significantly lower left ventricular (LV) ejection fraction (45.1 ± 10.8% vs 51.1 ± 9.7%; P = 0.021), a higher global wall motion score index (1.9 ± 0.3 vs 1.7 ± 0.4; P = 0.007), and greater LV MPI (0.65 ± 0.19 vs 0.47 ± 0.11; P = 0.001) than patients without. With the use of multivariate regression analysis, TDI-derived LV MPI (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.20-9.67; P = 0.022), the ratio of transmitral peak early (E) to late diastolic filling (A) velocities (E/A ratio) (OR, 0.41; 95% CI, 0.18-0.92; P = 0.031), and admission plasma glucose level (OR, 1.01; 95% CI, 1.0-1.02; P = 0.039) were independently associated with the presence of global RV dysfunction. CONCLUSIONS: In patients with a first acute STEMI without an associated RV infarction, depressed global LV function reflected by increased TDI-derived LV MPI, a lower mitral E/A ratio, and a higher glucose level on admission are independent correlates of early global RV dysfunction. Routine assessment of global RV function should be implemented in patients with STEMI with these characteristics.
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Hsu et al. (2013) conducted an observational in First acute ST-elevation myocardial infarction (STEMI) without right ventricular infarction (n=107). TDI-derived LV MPI, E/A ratio, and admission plasma glucose vs. Lower LV MPI, higher E/A ratio, and lower glucose was evaluated on Presence of global RV dysfunction (TDI-derived RV MPI > 0.55) (OR 3.40, 95% CI 1.20-9.67, p=0.022). Increased TDI-derived LV MPI (OR 3.40; 95% CI 1.20-9.67), lower E/A ratio, and higher admission glucose were independently associated with early global RV dysfunction in patients with acute STEMI.
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