부산대학교 도서관

Background: Right ventricular (RV) dysfunction is an independent predictor for adverse prognosis in inferior ST-elevation myocardial infarction (STEMI). We want to determine the long-term prognostic value of RV dysfunction with analysis of RV global longitudinal strain (GLSRV) in STEMI patients caused by occlusion of right coronary artery. Materials and Methods: We included consecutive patients with acute STEMI underwent primary percutaneous coronary intervention (PCI) for occlusion of right coronary artery (RCA) between January 2005 and December 2009. RV systolic function was assessed by measurement of GLSRV. RV dysfunction was defined as an RV fractional area change <35% on echocardiography. Results: We analyzed 194 consecutive patients (54 females, 64±12 years). Almost primary PCI performed by using drug-eluting stents (87%). Mean GLSRV was -15.9±4.2% and the best cutoff of value for detection of RV systolic dysfunction was -14% [Area under the curve (AUC)=0.889, p<0.001), with a sensitivity of 82 % and specificity 79%]. There were 31 major adverse cardiac events (MACE, 23 deaths, 5 target vessel revascularization, and 2 AMI) during the follow-up period (mean 61±22months). The Kaplan–Meier curve for overall 5-year MACE free survival indicated that higher GLSRV (≥-14%) had significantly lower survival (p=0.001). On Cox-regression analysis, GLSRV ≥-14% was associated with higher incidence of MACE (HR=2.2, 95% CI 1.0-4.5, p=0.04) when adjusted for age, gender, and Killip class≥2. Conclusions: In inferior STEMI caused by RCA occlusion, GLSRV showed good correlation with echocardiographic parameter of RV systolic function and higher GLSRV was associated with higher incidence of MACE. GLSRV can be a good prognostic factor in the predicting long–term MACE in these patients. Figure