Xiang Jin-Yi, Yu Ling-Yi, Zhao Yun, Wu Jing-Ping, Zheng Jin-Yu, Shi Ruo-Yang, Chen Bing-Hua, Pu Jun, Wu Lian-Ming
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China.
Eur Radiol. 2025 Jun 14. doi: 10.1007/s00330-025-11750-7.
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.
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.
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).
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.
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.
右心室心肌梗死（RVMI）是ST段抬高型心肌梗死（STEMI）的一个关键但常被忽视的方面，它对临床结局有重大影响。以往关于RVMI的心脏磁共振（CMR）特征和预后数据的研究得出了相互矛盾的结论。本研究旨在调查一大群患者中RVMI的CMR特征及其预后意义。
这项回顾性研究收集了两个中心连续诊断为STEMI的患者的急性CMR扫描数据。通过延迟钆增强和心肌水肿的存在来确定RVMI。主要终点是主要不良心血管事件（MACE）的复合终点，包括全因死亡率、再梗死和因心力衰竭住院。
共纳入1005例患者（平均年龄59.6±11.3岁；男性849例），在中位3.6年的随访期间，155例患者（15.4%）发生了MACE。199例患者（19.8%）被诊断为RVMI，这些患者的双心室功能和整体纵向应变较差（均p<0.001），MACE发生率较高（22.1%对13.78%，p=0.005）。RVMI独立预测左心室整体纵向应变（β=0.931，p=0.006）和圆周应变较差（β=0.661，p=0.049）。RVMI与MACE密切相关（调整后的危险比[HR]：1.45，95%置信区间[CI]：1.01-2.08，p=0.045），尤其是因心力衰竭住院（调整后的HR：2.66，95%CI：1.52-4.63，p=0.001）。
RVMI加重了左心室功能受损，并且在STEMI中与MACE独立相关，主要是由因心力衰竭住院风险增加所驱动。我们的研究结果强调了在STEMI的长期管理和风险分层中评估右心室的重要性。
问题CMR检测到的RVMI是否能独立预测STEMI患者的不良结局和心脏功能受损？研究结果在1005例STEMI患者中，19.8%发生了RVMI，并且与双心室功能较差和MACE风险高45%独立相关。临床意义CMR识别STEMI患者的右心室受累情况有助于更好地进行风险分层，并突出了加强监测的必要性，因为这些患者面临更高的心力衰竭住院风险和不良结局。
