Impaired RV global longitudinal strain is associated with poor long-term clinical outcomes in patients with acute inferior STEMI

JACC Cardiovasc Imaging. 2015 Feb;8(2):161-9. doi: 10.1016/j.jcmg.2014.10.011. Epub 2015 Jan 7.


Objectives: The aim of this study was to assess the long-term prognostic value of the global longitudinal strain of the right ventricle (GLSRV) in patients with inferior ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Background: RV systolic dysfunction is an important prognostic factor in patients with inferior STEMI.

Methods: All consecutive inferior STEMI patients were included from January 2005 to December 2013. RV systolic function was analyzed with GLSRV using velocity vector imaging (Siemens, Mountain View, California), as well as conventional echocardiographic indices, including right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE).

Results: We analyzed a total of 282 consecutive inferior STEMI patients (212 men, age 63 ± 13 years) treated with primary PCI. During the follow-up period (54 ± 35 months), 59 patients (21%) had 1 or more major adverse cardiovascular event (MACE) (43 deaths, 7 nonfatal MI, 4 target vessel revascularization, and 6 heart failure admission). The best cutoff value of GLSRV for the prediction of MACE was ≥-15.5% (area under the curve = 0.742, p < 0.001) with a sensitivity of 73% and a specificity of 65%. GLSRV showed better sensitivity and specificity than RVFAC and TAPSE. After multivariate analysis, GLSRV showed a higher c-statistic value (0.770) than RVFAC (0.749) and TAPSE (0.751) in addition to age, Killip class, troponin-I, left ventricular (LV) ejection fraction and RV infarction. Patients with GLSRV≥-15.5% showed significantly lower 5-year survival rate (74 ± 5% vs. 89 ± 3%, p < 0.001) and lower MACE-free survival rate (64 ± 5% vs. 87 ± 3%, p < 0.001) than the control group.

Conclusions: Because GLSRV showed additive predictive value to age and LV function, it can be the strongest parameter of RV systolic function evaluating the prognosis after PCI for acute inferior STEMI particularly in patients with preserved LV function.

Keywords: acute ST-segment elevation myocardial infarction; echocardiography; right ventricular function; strain echocardiography.

MeSH terms

  • Disease Progression
  • Echocardiography / methods*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Humans
  • Inferior Wall Myocardial Infarction / complications
  • Inferior Wall Myocardial Infarction / diagnostic imaging*
  • Inferior Wall Myocardial Infarction / surgery
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Prognosis
  • Retrospective Studies
  • Stroke Volume / physiology*
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / etiology*
  • Ventricular Dysfunction, Right / physiopathology
  • Ventricular Function, Right*