Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the Glycometabolic Intervention as Adjunct to Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial).
Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce. In a recent trial of patients with acute MI treated with primary PCI, in which the primary end point was left ventricular (LV) ejection fraction after 4 months measured with MRI, we conducted a prospectively defined substudy in which we examined RV function. RV ejection fraction (RVEF) and RV scar size were measured with MRI at 4 months. Tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (FWLS) were assessed using echocardiography before discharge and at 4 months. We studied 258 patients without diabetes mellitus; their mean age was 58 ± 11 years, 79% men and mean LV ejection fraction was 54 ± 8%. Before discharge, 5.2% of patients had TAPSE <17 mm, 32% had FWLS > -20% and 11% had FWLS > -15%. During 4 months, TAPSE increased from 22.8 ± 3.6 to 25.1 ± 3.9 mm (p <0.001) and FWLS increased from -22.6 ± 5.8 to -25.9 ± 4.7% (p <0.001). After 4 months, mean RVEF on MRI was 64.1 ± 5.2% and RV scar was detected in 5 patients (2%). There was no correlation between LV scar size and RVEF (p = 0.9), TAPSE (p = 0.1), or RV FWLS (p = 0.9). In conclusion, RV dysfunction is reversible in most patients and permanent RV ischemic injury is very uncommon 4 months after acute MI treated with primary PCI.
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: tm.gorter@umcg.nl.
Thomas M
TM
Gorter
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Chris P H
CP
Lexis
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Yoran M
YM
Hummel
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Erik
E
Lipsic
Department of Cardiology, Vrije University Medical Center, Amsterdam, the Netherlands.
Robin
R
Nijveldt
Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Tineke P
TP
Willems
Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Iwan C C
IC
van der Horst
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Pim
P
van der Harst
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Joost P
JP
van Melle
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Dirk J
DJ
van Veldhuisen
D000368:Aged; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016278:Ventricular Function, Right