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

• Published in: The International Journal of Cardiovascular Imaging Vol. 38; no. 3; pp. 631 - 641
• Main Authors: van Veelen, Anna, Elias, Joëlle, van Dongen, Ivo M., Hoebers, Loes P. C., Claessen, Bimmer E. P. M., Ramunddal, Truls, Laanmets, Peep, Eriksen, Erlend, van der Schaaf, René J., Nijveldt, Robin, Henriques, Jose P. S., Hirsch, Alexander
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2022; Springer Nature B.V
• Subjects: adverse effects; Cardiac and Cardiovascular Systems; Cardiac Imaging; Cardiology; complications; Coronary artery; Coronary Occlusion; Coronary Occlusion - complications; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - therapy; diagnostic imaging; Heart; Heart attacks; Humans; Imaging; Ischemia; Kardiologi; Magnetic resonance imaging; Medicine; Medicine & Public Health; methods; Myocardial infarction; Myocardium; Occlusion; Original Paper; Parameters; Percutaneous Coronary Intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Predictive Value of Tests; Radiology; Recovery; Right; Segments; ST Elevation Myocardial Infarction; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - therapy; therapy; Ventricle; Ventricular Function; Ventricular Function, Right; Strain analysis; ST-segment elevation myocardial infarction; Cardiovascular magnetic resonance; Chronic total occlusion; Right ventricle
• ISSN: 1569-5794; 1875-8312; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02423-9

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.