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Coronary artery disease
Original research
Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction
  1. Thomas Stiermaier1,2,
  2. Sören J Backhaus3,4,
  3. Jonas Matz3,4,
  4. Alexander Koschalka3,4,
  5. Johannes Kowallick4,5,
  6. Suzanne de Waha-Thiele1,2,
  7. Steffen Desch6,
  8. Matthias Gutberlet7,
  9. Gerd Hasenfuß3,4,
  10. Holger Thiele6,
  11. Ingo Eitel1,2,
  12. Andreas Schuster3,4
  1. 1 Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany
  2. 2 German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
  3. 3 Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
  4. 4 German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
  5. 5 Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
  6. 6 Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
  7. 7 Department of Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
  1. Correspondence to Dr Ingo Eitel, Luebeck, Germany; Ingo.Eitel{at}uksh.de

Abstract

Objective Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking. Therefore, the aim of this trial was to assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI.

Methods Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (ST-elevation myocardial infarction: n=795; non-STEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (oedema representing reversible ischaemia, irreversible infarction, microvascular obstruction (MVO)) and functional (ejection fraction, global longitudinal strain (GLS)) RV alterations. The clinical end point was the 12-month rate of major adverse cardiac events (MACE).

Results RV ischaemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischaemia was associated with a significantly increased risk of MACE (10.1% vs 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% vs 3.8%; p<0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (HR 1.05, 95% CI 1.00 to 1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020) and left ventricular GLS (p=0.001), while RV ischaemia was not independently associated with outcome.

Conclusions RV GLS is a predictor of postinfarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome.

  • acute myocardial infarction
  • cardiac magnetic resonance (CMR) imaging

https://doi.org/10.1136/heartjnl-2020-317184

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    Footnotes

    • IE and AS are joint senior authors.

    • IE and AS contributed equally.

    • Contributors All authors gave substantial contributions to the conception or design of the work; and/or the acquisition, analysis or interpretation of data; and/or drafting the work or revising it critically for important intellectual content. All authors approved the final version published. TS, IE and AS are accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The study was supported by a grant from the German Center for Cardiovascular Research (DZHK).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Both studies (AIDA STEMI and TATORT NSTEMI) were approved by all involved ethical committees and complied with the principles of the Helsinki Declaration. All patients gave written informed consent for study participation.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.