Right ventricular-pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool.

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Hellenic Journal of Cardiology Pub Date : 2024-07-06 DOI:10.1016/j.hjc.2024.07.002

Vasileios Anastasiou, Stylianos Daios, Dimitrios V Moysidis, Alexandros C Liatsos, Andreas S Papazoglou, Matthaios Didagelos, Christos Savopoulos, Jeroen J Bax, Antonios Ziakas, Vasileios Kamperidis

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Abstract

Background: The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored.

Objective: This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization.

Methods: Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded.

Results: The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03-0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ² 26.55) was significantly improved by adding LVEF ≤40% (χ² 44.71, P < 0.001), TAPSE ≤ 17 mm (χ² 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ² 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality.

Conclusion: RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI.

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首次急性心肌梗死患者的右心室-肺动脉耦合：一种新兴的血管重建后分流工具。

背景：三尖瓣环平面收缩期偏移/肺动脉收缩压（TAPSE/PASP）是右心室-肺动脉（RV-PA）耦合的无创替代指标，曾在慢性 RV 压力超负荷综合征中进行过研究。然而，它在可能导致急性 RV 压力超负荷的急性心肌梗死（AMI）患者中的预后作用仍有待探索：目的：确定首次急性心肌梗死患者 RV-PA 解耦的预测因素，并研究其是否能改善心血管再通术后心血管病院内死亡率的风险分层：连续对 300 名首次急性心肌梗死患者进行了前瞻性研究（年龄为 61.2±11.8，女性占 24%）。成功血管再通后 24 小时进行超声心动图检查，并评估 TAPSE/PASP。记录了心血管疾病的院内死亡率：结果：确定心血管病院内死亡率的最佳TAPSE/PASP临界值为0.49 mm/mmHg。TAPSE/PASP≤0.49毫米/毫米汞柱的患者应考虑RV-PA解耦。左心室射血分数（LVEF）与 RV-PA 解耦独立相关。尽管成功进行了血管重建，但仍有 23 名（7.7%）患者在院内死亡。在调整全球心血管事件登记处（GRACE）风险评分和 LVEF 后，TAPSE/PASP 与院内死亡率独立相关（Odds Ratio 0.14，95% 置信区间 [0.03-0.56]，P-value 0.007）。包括 GRACE 风险评分和 NT-pro-BNP 的基线模型（χ2 26.55）的预后价值在加入 LVEF ≤40 % 后显著提高（χ2 44.71，P-value 2 75.42，P-value 2 101.74，P-value 结论：血管再通后 24 小时超声心动图 TAPSE/PASP ≤0.49 mm/mmHg 评估的 RV-PA 解耦可改善首次急性心肌梗死后心血管住院死亡率的风险分层。

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来源期刊

Hellenic Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

7.30%

发文量

审稿时长

56 days

期刊介绍： The Hellenic Journal of Cardiology (International Edition, ISSN 1109-9666) is the official journal of the Hellenic Society of Cardiology and aims to publish high-quality articles on all aspects of cardiovascular medicine. A primary goal is to publish in each issue a number of original articles related to clinical and basic research. Many of these will be accompanied by invited editorial comments. Hot topics, such as molecular cardiology, and innovative cardiac imaging and electrophysiological mapping techniques, will appear frequently in the journal in the form of invited expert articles or special reports. The Editorial Committee also attaches great importance to subjects related to continuing medical education, the implementation of guidelines and cost effectiveness in cardiology.