title: Reperfusion correlates and clinical outcomes of right ventricular dysfunction in patients with inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.
abstract: We evaluated the relation between reperfusion indexes and right ventricular (RV) dysfunction in patients with inferior ST-segment elevation myocardial infarction (STEMI). We included patients with inferior STEMI undergoing percutaneous coronary intervention and right coronary artery as infarct-related artery. Myocardial reperfusion was evaluated by Thrombolysis In Myocardial Infarction (TIMI) flow, TIMI frame count, myocardial blush grade, and ST-segment resolution. RV dysfunction was defined as tricuspid annular plane systolic excursion≤16 mm in M-mode imaging. RV dysfunction was present in 58 of 141 patients (41.1%) and was more frequent in patients achieving suboptimal postprocedural TIMI flow grade (66.7% vs 36.7%, grades 0 to 2 vs 3, p=0.01), TIMI frame count (63.2% vs 37.7%, ≥40 vs <40 frames, p=0.04), and myocardial blush grade (33.3% vs 56.2%, grade 0 or 1 vs 2 or 3, p=0.001). RV dysfunction rates did not differ according to ST-segment resolution. Patients with RV dysfunction had increased rates of cardiac death (13.2% vs 2.6%, p=0.03), reinfarction (24.5% vs 10.3%, p=0.03), and stent thrombosis (22.6% vs 6.4%, p=0.01) at 2-year follow-up. Postprocedural TIMI flow grade 3 (odds ratio 0.25, 95% confidence interval 0.09 to 0.68, p=0.007) was the only reperfusion correlate of RV dysfunction at multivariate analysis. In an independent cohort of 84 patients with STEMI, postprocedural TIMI flow grade 3 had a limited sensitivity (52%), with a high specificity (74.5%) and negative predictive value (71%) for excluding RV dysfunction. In conclusion, in patients with inferior STEMI undergoing coronary revascularization, RV dysfunction is associated with a worse long-term prognosis. Postprocedural TIMI flow grade may be a useful tool to predict RV dysfunction.
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Raffaele
authors: R
authors: Piccolo
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Tullio
authors: T
authors: Niglio
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Letizia
authors: L
authors: Spinelli
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Ernesto
authors: E
authors: Capuano
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Teresa
authors: T
authors: Strisciuglio
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Carolina
authors: C
authors: D'Anna
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Stefania
authors: S
authors: De Luca
authors: Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
authors: Dario
authors: D
authors: Leosco
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Antonio
authors: A
authors: Rapacciuolo
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Plinio
authors: P
authors: Cirillo
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Eugenio
authors: E
authors: Stabile
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Giovanni
authors: G
authors: Esposito
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors: Bruno
authors: B
authors: Trimarco
authors: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors: Federico
authors: F
authors: Piscione
authors: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. Electronic address: gengalas@unina.it.
authors: Gennaro
authors: G
authors: Galasso
mesh_terms: D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*