Recovery of right ventricular function and strain in patients with ST-segment elevation myocardial infarction and concurrent chronic total occlusion

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.

The Relationship between the Levels of Serum Cystatin C and the Occurrence of the No-Reflow Phenomenon during Primary Percutaneous Coronary Interventions

“…The amount of blood needed for the research is 1.5 c.c, Blood samples were collected using standardized sterile tubes and centrifuged at 3000 rpm for 5min at 4°C, and the serum and plasma was immediately frozen and stored at -80°C until being assayed, Serum cystatin C concentration was measured by high sensitive latex particleenhanced immunoturbidimetric assay with an automatic biochemical analyzer (Hitachi 7600; Tokyo, Japan), which was also used for the measurement of high-sensitivity C-reactive protein (hsCRP) and Other blood tests including lipids, troponin I, and creatinine, etc. were assayed using routine laboratory methods [12] .…”

Predictive Role of Infarct Related Artery in Acute Right Ventricular Infarction Diagnosed Using Electrocardiography

“…These finding were consistent with the data from the literature that showed deterioration of RV function due to the acute RCA proximal occlusion. Among the data few features were found to be useful in predicting proximal RCA stenosis: enlarged RV mid-dimension, reduced TAPSE, myocardial performance index by tissue Doppler imaging (MPI-TDI) and velocity of the tricuspid annular systolic motion (RV S') as well reduced global and/or free-wall RV longitudinal strain detected either with echocardiography or with cardiac magnetic resonance [26][27][28][29][30][31].…”

Recovery of right ventricular function and strain

“…For this March 2022 issue, I would like to recommend the paper by A. Van Veelen and co-authors from a number of university medical centers under the supervision of A Hirsch from the Erasmus University Medical Center in Rotterdam, The Netherlands [1]. The topic of this paper is the investigation of the right ventricular (RV) function in STEMI patients with concurrent chronic total occlusion (CTO).…”