title: Determinants of right ventricular remodeling following ST-segment elevation myocardial infarction.
abstract: Right ventricular (RV) function after ST-segment elevation myocardial infarction (STEMI) has important prognostic implications. However, the changes in RV function over time after STEMI and the incidence of RV remodeling remain unknown. The present study evaluated changes in RV dimensions and function in contemporary patients with first STEMI and assessed the independent determinants of RV dysfunction at follow-up. Patients with first STEMI (n = 940, 60 ± 11 years, 77% men) treated with primary percutaneous coronary intervention underwent echocardiography at baseline and 6- and 12-month follow-up. The prevalence of RV dysfunction (tricuspid annular plane systolic excursion [TAPSE] ≤15 mm) decreased significantly at 6 months follow-up (from 15% to 8%, p <0.001) and the incidence of RV remodeling (increase in RV end-diastolic area [RVEDA] ≥20%) was observed in 200 patients (25%). Absolute changes in RVEDA were independently associated with absolute changes in wall motion score index and left ventricular (LV) remodeling (p <0.001 for both parameters), whereas absolute changes in TAPSE were independently related with absolute changes in wall motion score index and mitral regurgitation grade (p <0.001 for both parameters). Independent correlates of RV dysfunction at 6 months follow-up were multivessel coronary disease (odds ratio [OR] 2.13), peak cardiac troponin T (OR 1.05), angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers use (OR 0.27), baseline LV ejection fraction (OR 0.96) and baseline TAPSE (OR 0.88). In conclusion, despite the non-negligible incidence of RV remodeling in patients with first STEMI, RV function improves early after STEMI. Multivessel coronary disease, infarct size, baseline LV ejection fraction and TAPSE and the nonuse of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers are independent determinants of RV dysfunction.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Georgette E
authors.initials: GE
authors.lastname: Hoogslag
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marlieke L A
authors.initials: ML
authors.lastname: Haeck
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Matthijs A
authors.initials: MA
authors.lastname: Velders
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Helèn
authors.initials: H
authors.lastname: Boden
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D013318:Stroke Volume; D016278:Ventricular Function, Right / Q000502:physiology*; D020257:Ventricular Remodeling