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.
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Article info
Publication history
Published online: August 26, 2014
Accepted:
August 5,
2014
Received in revised form:
August 5,
2014
Received:
June 16,
2014
Footnotes
The authors Georgette E. Hoogslag and Marlieke L.A. Haeck contributed equally to the work and share first authorship.
See page 1495 for disclosure information.
Identification
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
