Impact of first myocardial infarction on the right ventricle: A magnetic resonance-based assessment
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Authors
Borguezan Daros C.
Stevenson A.
Patel K.
Panoulas V.
Kabir T.
Dalby M.
Bucciarelli-Ducci C.
Meredith B.
Pierce I.
Moon J.
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Issue Date
2026
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Conference Proceedings
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Abstract
Background: Right ventricular (RV) dysfunction and RV myocardial infarction frequently complicate acute myocardial infarction (AMI), but it is markedly underrecognised in the absence of haemodynamic compromise. Cardiac magnetic resonance (CMR) imaging is the gold standard for evaluation of the right ventricle. CMR defined RV infarction in the acute setting has been suggested to have prognostic importance. However, limited data exists on the long-term impact that RV involvement in a first AMI has on clinical outcomes. We therefore characterized the RV with CMR at 30-90 days in an unselected cohort of patients from two large-volume primary angioplasty centres, following first acute myocardial infarction. Aims and Methods: Consecutive patients diagnosed with a first AMI were retrospectively assessed, after they had undergone primary percutaneous coronary intervention (PCI) between 2016 and 2022. Multiparametric CMR scans to assess ventricular function and contrast enhanced imaging were performed between 30-90 days (median 51 days) following admission (scanned at 1.5T). RV infarction was defined as RVEF of < 40%, or one or more dysfunctional RV segments associated with LGE. Patients with a non-ischaemic CMR phenotype were not included in this cohort. Clinical data was collected from medical records. Result(s): 399 patients with a first AMI were included (mean age 57.9 years, 82% male). RV infarction was observed in 16.3% of patients. In patients with RV infarction 46.2% had undergone PCI to the LAD, 38.5% to the RCA and 20.7% to the LCx territories. Multi-vessel PCI in their index procedure were no more likely to experience an RV infarct. Clinical risk factors including hypertension, diabetes, chronic renal failure, troponin and Killip Class were not associated with higher rates of RV infarction. RV infarction resulted in lower RVEF (52 vs 60%; p<0.001) and reduced RV GLS (22.1 vs 26.3; p<0.001) as well as other strain parameters. RV infarcts were seen more commonly in patients with lower LVEF (52 vs 60%; p<0.001) and with higher numbers of dysfunctional/infarcted LV segments (6.5 vs 3.9; p <0.001 and 7.1 vs 5.4; p<0.001), as well as reduced LV GLS (13.6% vs 15.2%; p<0.001) and other strain parameters. The presence of RV LGE, was also associated with a lower RVEF (53% vs 59%; p<0.001). The overall cohort mortality at a median of 5.3 years (range 1.0 - 9.4 years) follow-up was 4.0%, consistent with current day primary angioplasty outcomes. RV infarction was not associated with higher mortality (p = 0.072). Conclusion(s): In a cohort of first AMIs undergoing primary PCI, the prevalence of RV infarction was 16.3%, as defined on CMR at 30-90 days. RV infarction was associated with an overall mild reduction in RVEF, larger LV infarcts, widespread RV and LV strain abnormalities, but not adverse outcome. In our cohort RV infarction may thus be associated with relatively benign sequelae following early appropriate revascularization. (Table present).
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European Heart Journal Cardiovascular Imaging
Volume
27