Suche

Right Ventricular to Pulmonary Artery Uncoupling is Associated with 1-Year Mortality in Patients with Acute ST-Elevation Myocardial Infarction

https://doi.org/10.1007/s00392-025-02625-4

Christian Gräßer (München)1, J. Bresha (München)2, F. Roski (München)1, E. Petersen (München)1, J. Krefting (München)3, M. von Scheidt (München)1, C. Friess (München)1, K. Knoll (München)1, J. Tervooren (München)2, T. Ibrahim (München)2, A. Steger (München)2, C. Bradaric (München)2, E. Xhepa (München)1, H. Schunkert (München)1, K.-L. Laugwitz (München)2, H. Sager (München)1, T. Keßler (München)1, A. Kastrati (München)1, M. Lachmann (München)2, A. M. Müller (München)2, T. Trenkwalder (München)1

1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; 2Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin I München, Deutschland; 3Deutsches Herzzentrum München Klink für Herzkreislauferkrankungen München, Deutschland

 

Background: 

Identifying high-risk patients following acute ST-elevation myocardial infarction (STEMI) remains an important clinical challenge, despite well-documented risk factors for adverse outcomes. Right ventricular to pulmonary artery (RV-PA) coupling, a measure of right ventricular function put into context to the afterload from the pulmonary circulation, can be readily assessed via echocardiography and has emerged as a promising prognostic marker in critically ill patients. 

 

Objective: 

This study aims to evaluate the prognostic relevance of RV-PA coupling in patients undergoing primary percutaneous coronary intervention (pPCI) for acute STEMI.

 

Methods and Results: 

This analysis includes patients treated with pPCI for acute STEMI between 2014 and 2022 at two tertiary cardiac centers in Germany (German Heart Center Munich: derivation cohort; Klinikum rechts der Isar: validation cohort). Echocardiography was performed after pPCI and prior to discharge. RV-PA coupling was calculated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary arterial pressure (sPAP). Using maximally selected log-rank statistics, an optimal cut-off value for TAPSE/sPAP ratio was identified to predict 1-year mortality in the derivation cohort and subsequently validated in the external cohort.

In total, the study analyzed data from 973 STEMI patients (median age: 62.8 years [IQR: 54.0-75.5 years]; 23.4% female). At 1-year follow-up, overall survival was 95.1% (95% CI: 93.7-96.4%). In the derivation cohort, a TAPSE/sPAP ratio cut-off of 0.405 mm/mmHg effectively stratified patients into low- and high-risk groups. Testing in the validation cohort confirmed the prognostic value, meaning that patients with TAPSE/sPAP <0.405 (defining RV-PA uncoupling) showed a significantly worse 1-year survival after pPCI for acute STEMI than those with preserved RV-PA coupling (96.8% [95% CI: 95.6-97.9%] vs. 72.9% [63.2-84.1%]; hazard ratio for 1-year mortality: 9.62 [95% CI: 5.39-17.2]; p-value: <0.001). 

Additionally, TAPSE/sPAP outperformed TAPSE alone in predicting 1-year mortality, as demonstrated by receiver operating characteristic curve analysis (AUC: 0.732 [95% CI: 0.643-0.821] vs. 0.643 [95% CI: 0.537-0.732], p-value: 0.018). Multivariate analysis confirmed that RV-PA coupling independently predicted 1-year mortality, alongside age, renal function, and myocardial damage indicated by creatine kinase levels.

 

Conclusion: 

RV-PA uncoupling, indicated by a TAPSE/sPAP ratio below 0.405 mm/mmHg, is a robust, independent predictor of 1-year all-cause mortality in acute STEMI patients. This measure may help identify high-risk patients early in their treatment course. Future studies are needed to explore strategies to improve survival among these high-risk individuals. 


Diese Seite teilen