Prognostic Value of Right Ventricular Longitudinal Shortening Fraction in Patients With ST-Elevation Myocardial Infarction: A Prospective Echocardiography Study

Abstract

Background: Right ventricular systolic dysfunction (RVsD) frequently occurs in patients with ST-elevation myocardial infarction (STEMI). However, the diagnosis depends on the echocardiographic parameters to define RVsD. Right ventricle longitudinal shortening fraction (RV-LSF) is an accurate and reproducible two-dimensional speckle tracking parameter associated with clinical events in various pathologies.Objective: The aim of the study is to evaluate the association between RVsD and major adverse cardiovascular events (MACE) occurrence in a cohort of STEMI patients.Methods: Adult STEMI patients admitted to Amiens University Hospital's cardiovascular intensive care unit between May 2021 and November 2022, who underwent coronary angiography and TTE within 48 hours of admission, were included. RVsD was defined as RV-LSF < 20%. The primary outcome was MACE occurrence, including heart failure, myocardial infarction, stroke, and death within six months of admission. Multivariable Cox regression analysis with proportional hazard ratio (HR) models assessed the association between RVsD and MACE.Results: Among the 164 included patients, 72 (44%) had RVsD, and 92 (56%) did not. The RVsD group had a significantly higher proportion of MACE during the six-month follow-up (n = 23/72, 33%) than the no-RVsD group (n = 8/92, 9%; P = 0.001). RVsD showed an independent association with MACE at six months (HR=3.1, 95% CI [1.35-7.30], P=0.008). Left ventricular ejection fraction < 40 % and TIMI score > 4 were independently associated with RVsD (odds ratio = 2.80, 95% CI [1.34-5.98] and OR=2.15, 95% CI [1.18-4.39 respectively]; P = 0.015). The cumulative risk of MACE at six months was 33% for RV-LSF < 20% and 9% for RV-LSF ≥ 20% (log-rank test P < 0.001).Conclusion: RVsD, defined by RV-LSF < 20%, is associated with an increased risk of MACE after STEMI.