Right ventricular myocardial infarction: cardiac magnetic resonance characteristics and prognostic implications.

OBJECTIVES

Right ventricular myocardial infarction (RVMI) is a critical yet often underrecognized aspect of ST-segment elevation myocardial infarction (STEMI) that significantly influences clinical outcomes. Previous studies reached contradictory conclusions about the cardiac magnetic resonance (CMR) characteristics and prognostic data with RVMI. This study sought to investigate the CMR characteristics and prognostic implications of RVMI in a large cohort.

MATERIALS AND METHODS

This retrospective study collected acute CMR scans from consecutive patients diagnosed with STEMI at two centers. RVMI was identified by the presence of late gadolinium enhancement and myocardial edema. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause mortality, reinfarction, and hospitalization for heart failure.

RESULTS

A total of 1005 patients (mean age 59.6 ± 11.3 years; 849 males) were included, and MACE occurred in 155 patients (15.4%) during a median of 3.6 years of follow-up. RVMI is identified in 199 patients (19.8%), who exhibit worse biventricular function and global longitudinal strain (all p < 0.001) and higher MACE incidence (22.1% vs 13.78%, p = 0.005). RVMI independently predicts worse LV global longitudinal (β = 0.931, p = 0.006) and circumferential strain (β = 0.661, p = 0.049). RVMI is strongly associated with MACE (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 1.01-2.08, p = 0.045), particularly hospitalization for heart failure (adjusted HR: 2.66, 95% CI: 1.52-4.63, p = 0.001).

CONCLUSION

RVMI aggravated the impaired LV function and was independently associated with MACE in STEMI, mainly driven by an increased risk of hospitalization for heart failure. Our findings underscore the importance of RV assessment in STEMI's long-term management and risk stratification.

KEY POINTS

Question Does RVMI detected by CMR independently predict adverse outcomes and impaired cardiac function in patients with STEMI? Findings In 1005 STEMI patients, RVMI occurred in 19.8% and was independently associated with worse biventricular function and a 45% higher risk of MACE. Clinical relevance CMR identification of right ventricular involvement in STEMI patients enables better risk stratification and highlights the need for enhanced monitoring, as these patients face higher risks of heart failure hospitalization and adverse outcomes.