Abstract
The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (− 26.0 ± 8.3% versus − 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.
Highlights
MethodsAssessment of the right ventricular (RV) function has prognostic implications in patients with ischemic heart disease [1]
Baseline cardiovascular magnetic resonance imaging (CMR) was performed at a median of 3 days (IQR 2–5) after primary percutaneous coronary intervention (PCI)
Patients were divided into the three groups according to right coronary artery (RCA) involvement: (1) chronic total occlusion (CTO)-RCA (n = 89); 2) infarct-related artery (IRA)-RCA (n = 56); 3) no-RCA
Summary
MethodsAssessment of the right ventricular (RV) function has prognostic implications in patients with ischemic heart disease [1]. RV strain measurements are associated with global RV function and prognosis in patients with acute myocardial infarction [4–7]. In 15% of patients with an acute ST-segment elevation myocardial infarction (STEMI) a concomitant chronic total occlusion (CTO) is found—a 100% coronary lumen narrowing that is older than 3 months [8, 9]. In these patients, the RV function is frequently affected when the right coronary artery (RCA) is the infarct-related artery (IRA) or the CTO-related artery [10]. RV dysfunction resulting from CTO RCA has been thought to be able to improve [12]. Whether this is due to successful revascularization of CTO RCA, the development of a collateral network or to a temporal effect of hibernation has not yet been established
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