Refaat Hesham, Arab Mohamed
Cardiology Department, Zagazig University, Zagazig, Egypt.
Echocardiography. 2025 Jun;42(6):e70223. doi: 10.1111/echo.70223.
Right ventricular (RV) infarction complicates one-third of inferior ST-segment elevation myocardial infarctions (STEMI). Our aim was to evaluate RV function to assess its in-hospital and long-term prognostic value.
We enrolled 247 patients with inferior STEMI treated with primary angioplasty. Echocardiography was performed within 48 h and after 6 months, including RV myocardial performance index (RVMPI), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVGLS), and pulmonary artery systolic pressure (PASP). Major adverse cardiac events (MACE) were reported during the 6-month follow-up. The patients were categorized into MACE and non-MACE groups.
In patients with MACE, RV diastolic dysfunction occurred earlier as evidenced by lower E' wave velocity (5.8 ± 1.03 vs. 9.1 ± 2.8 cm/s, p = 0.04) and higher E/E' (10.1 ± 3.1 vs. 6.1 ± 2.3, p = 0.03). After 6 months, distorted RV geometry and RV systolic dysfunction, evidenced by lower RVFAC (32.2 ± 3.6% vs. 38.06 ± 3.9%, p = 0.04), lower TAPSE (14.6 ± 1.2 vs. 17.3 ± 1.7 mm, p = 0.02), higher RVGLS (-14.5 ± 2.6% vs. -17.5 ± 1.2%, p = 0.04), and higher PASP (29.8 ± 3.2 vs. 24.1 ± 2.2 mmHg, p = 0.01), were reported later on. Multivariate analysis documented E' wave velocity, E/E', RVFAC, and TAPSE as strong predictors of MACE.
In inferior STEMI, RV diastolic dysfunction occurs earlier in patients with MACE. However, RV systolic dysfunction and impaired RV geometry develop later on. E' wave velocity, E/E', RVFAC, and TAPSE are strong independent predictors of MACE.
右心室（RV）梗死在三分之一的下壁ST段抬高型心肌梗死（STEMI）中并发。我们的目的是评估右心室功能，以评估其住院期间和长期的预后价值。
我们纳入了247例接受直接血管成形术治疗的下壁STEMI患者。在48小时内及6个月后进行超声心动图检查，包括右心室心肌做功指数（RVMPI）、右心室面积变化分数（RVFAC）、三尖瓣环平面收缩期位移（TAPSE）、右心室整体纵向应变（RVGLS）和肺动脉收缩压（PASP）。在6个月的随访期间报告主要不良心脏事件（MACE）。将患者分为MACE组和非MACE组。
在发生MACE的患者中，右心室舒张功能障碍出现得更早，表现为E'波速度更低（5.8±1.03对9.1±2.8cm/s，p=0.04）和E/E'更高（10.1±3.1对6.1±2.3，p=0.03）。6个月后，出现了右心室几何形状扭曲和右心室收缩功能障碍，表现为RVFAC更低（32.2±3.6%对38.06±3.9%，p=0.04）、TAPSE更低（14.6±1.2对17.3±1.7mm，p=0.02）、RVGLS更高（-14.5±2.6%对-17.5±1.2%，p=0.04）和PASP更高（29.8±3.2对24.1±2.2mmHg，p=0.01）。多因素分析表明E'波速度、E/E'、RVFAC和TAPSE是MACE的强预测因素。
在下壁STEMI中，发生MACE的患者右心室舒张功能障碍出现得更早。然而，右心室收缩功能障碍和右心室几何形状受损随后才出现。E'波速度、E/E'、RVFAC和TAPSE是MACE的强独立预测因素。
