238Prognostic value of right ventricular function assessed by the tricuspid annular plane systolic excursion in acute myocardial infarction


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Abstract

Background. Right ventricular dysfunction predicts adverse prognosis in patients with ST-elevation myocardial infarction (STEMI). The prognostic value in non-ST elevation myocardial infarction (NSTEMI) is unsettled.Aim: To determine the prognostic value of right ventricular (RV) function in patients with STEMI and NSTEMI.Methods: Two-dimensional echocardiograms were obtained in 383 patients (250 males, age 71 ± 13 years) admitted for acute myocardial infarction (AMI: 134 STEMI, 249 NSTEMI). RV function was assessed from the apical four-chamber view 2D echo-guided M-Mode by measurement of tricuspid annular plane systolic excursion (TAPSE) scored from 0 = normal to 3 = severely abnormal (0 = >20 mm, 1 = 20–16 mm, 2 = 15–10 mm, 3 = <10 mm).Results: Median follow-up was 7 months (interquartile range, 2-14). Ninety-eight hard events occurred (death or AMI). TAPSE score predicts infarction-free survival in AMI (see figure). On univariate analyses, this score was a predictor of hard events in patients with STEMI and NSTEMI (p <.0001 for all). After adjusting for coronary artery disease risk factors ≥ 3, previous MI, troponin peak, GRACE risk score, Left Ventricular Ejection Fraction, Wall Motion Score Index, WMSI, TAPSE score remained an independent predictor of hard events in patients admitted with STEMI (H.R. 1.93, 95% CI 1.23-3.03, p=.004) and NSTEMI (H.R. 1.61, 95% CI 1.16-2.22, p=.004).Conclusions: RV dysfunction assessed by TAPSE predicts hard events in patients with STEMI and NSTEMI.

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