Right ventricular function assessed by 2D strain analysis predicts ventricular arrhythmias and sudden cardiac death in patients after acute myocardial infarction

Aims: Left ventricular function is a well-established predictor of malignant ventricular arrhythmias, but little is known about the importance of right ventricular (RV) function. The aim of this study was to investigate the importance of RV function for prediction of sudden cardiac death (SCD) or malignant ventricular arrhythmias (VAs) after acute myocardial infarction (MI).

Methods and results: A total of 790 patients with acute MI were prospectively included. All patients had 2D strain echocardiography performed to evaluate right ventricular (RV) free wall strain (RVS) and RV mechanical dispersion (MD) defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite end point [SCD, admission with VA or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator (ICD)] was analysed with Cox models. Mean age was 69 ± 12 years, and 74% were male. Thirty-one patients experienced the primary end point during a median follow-up of 898 days (Q1-Q3 704-981). RVS was independently associated with outcome in a multivariable model including age and left ventricular global longitudinal strain; pr 1% change [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.01-1.15; P = 0.038]. Patients in the lower tertile (poor strain) showed a 10-fold risk of an event compared with the upper tertile (HR 9.8, 95% CI 2.23-42.3; P = 0.002). RV MD was not independently associated with VA/SCD (HR 0.99, 95% CI 0.91-1.09; P = 0.93). RVS proved superior to tricuspid annular plane systolic excursion (TAPSE) (P = 0.03) in the multivariable model.

Conclusion: RVS, but not RV MD, was significantly and independently related to SCD/VA in patients with acute MI. Furthermore, RVS was shown to be superior to TAPSE.