Right ventricular strain and tricuspid annular plane systolic excursion are associated with mortality in inferior ST-elevation myocardial infarction

Background

Patients with inferior ST-segment elevation myocardial infarction face a substantial risk for cardiovascular death. While left ventricular function is known to be associated with clinical outcomes in these patients, we evaluated the prognostic impact of tricuspid annular plane systolic excursion (TAPSE) and advanced measures of right ventricular function (free wall strain [FWS] and global longitudinal strain [RVGLS]).

Methods

Consecutive patients presenting with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention between 01/2012 and 08/2015 were retrospectively analysed. Associations between RV strain measurements and all-cause mortality were evaluated using Cox regression analysis.

Results

207 patients (69.6% male, median 59.0 [IQR: 52.1–70.7] years) were followed for 8.3 (IQR: 7.4–9.3) years, during which 49 patients (23.7%) deceased. Median right ventricular function parameters were significantly better in surviving patients (RVGLS: −17.5% vs. −13.3%, p < .001; FWS: −20.5% vs. −14.8%, p < .001; TAPSE 1.8 cm vs. 1.3 cm, p < .001). All 3 parameters were associated with mortality in univariate and multivariable analysis adjusted for age, sex and the number of comorbidities (chronic kidney disease, hypercholesterinaemia, diabetes mellitus) (adj. hazard ratio [HR] per 1 standard deviation: RVGLS: 1.68 [95% CI: 1.27–2.23, p < .001], FWS: 1.56 [95% CI: 1.56–2.00, p < .001], TAPSE: 1.55 [95% CI: 1.17–2.05, p = .002]). Additionally, right ventricular function was inversely associated with peak troponin T and creatine kinase levels.

Conclusions

Among patients with inferior ST-segment myocardial infarction, RVGLS, FWS and TAPSE convey crucial prognostic information and might help to identify patients at increased risk requiring intensified monitoring and therapy.